This article has been updated.

Recent data in Bexar County indicates a slow climb in COVID-19 infections, although as in many places, hospitalizations and deaths remain low.

Yet with just under 40% of the county fully vaccinated and boosted, high-risk populations remain at risk. The good news is that there are three treatment options available locally. 

But which treatment is right — and whether treatment is even necessary — depends on a person’s individual risk factors.

Those in the high-risk category include people over age 65, those who have existing conditions such as diabetes, heart or lung disease, and those who are immunosuppressed, said Dr. Jason Bowling, epidemiologist and infectious disease doctor at University Health. 

He urged anyone who is COVID-positive and high risk or pregnant to reach out to their primary care doctor to learn what treatment options make the most sense for them.

The only way to know for sure if an illness is COVID-19 is to get tested. That’s why public health officials are still urging residents who think they may have been exposed to get tested, even if symptoms are mild. That way, even those who may not need treatment, because they are low risk or have mild symptoms, can avoid spreading the virus to others who may not be so lucky.

Free at-home tests can be ordered online from the federal government, and through private health insurance plans. In addition, several sites in San Antonio still offer free COVID-19 testing.

Those who are uninsured, do not have a primary care doctor or are looking for convenience can get tested and treated, if necessary, at one of several locations in Bexar County supported by the federal government, which has partnered with pharmacies like CVS and Walgreens, long-term care facilities and community health centers to support free “Test-to-Treat” one-stop-shops. Typing a zip code into this online locator shows nearby sites.

The San Antonio Metropolitan Health District runs one of those Test-to-Treat sites. Walk-ups and drive-through are welcome from 7 a.m. to 7 p.m. each day at 7142 San Pedro Ave., no appointment is required, confirmed a spokeswoman with Metro Health.

Those who test positive at the clinic then get access to a medical provider, who can prescribe a monoclonal antibody infusion, which happens onsite, or an oral antiviral treatment, depending on the person’s medical history and date of symptom onset.

The prescription for oral antivirals is then filled at the H-E-B of the patient’s choice at no cost.

Bowling, who treats COVID-19 patients at University Health hospital, explained the three treatment options. 

Monoclonal antibody infusions work by binding to spike proteins of the virus, keeping the virus from attaching itself to cells, limiting the spread of the infection and reducing the severity of illness.

As variants evolve and mutate, monoclonals are often reformulated, said Bowling. Infusions are considered the best option for those who take several prescriptions, as it avoids potential drug interactions. This includes organ transplant recipients and cancer patients. 

Because the federal government has purchased a number of monoclonal antibody treatments, there is often no cost to the patient, but there may be costs for administering the infusion, according to the Department of Health and Human Services. Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) cover the cost of infusions.

Texas residents can call the state’s infusion hotline at 1-800-742-5990 for more information on where are how to get the treatment.

For high-risk patients not on other medications, two oral antivirals are available: Paxlovid, made by Pfizer, and molnupiravir from Merck. The Biden Administration has committed to purchasing 20 million “treatment courses” of Paxlovid, and while the drug was initially hard to find, the White House now says there is “ample supply.”

Both antivirals must be started within five days of initial symptom onset and must be taken twice a day for five days. Molnupiravir is not authorized for patients under 18 or who are pregnant, according to the U.S. Food and Drug Administration. Those who are pregnant should consult with a primary care physician before taking Paxlovid, which is available for patients 12 and over.

Bowling noted that Paxlovid appears to be more effective, according to medical studies. 

“Paxlovid had about an 88%… reduction in hospitalizations and death,” Bowling said, while “molnupiravir reduction in hospitalization or death was only 30%.” 

During earlier waves of the pandemic, availability of treatments were often limited. Bowling said these days, there’s been “pretty good” availability. 

Still, Bowling said, “The best thing to do is to get vaccinated and then boosted, so that you have some baseline level of protection.”

After that, it’s important to know what treatment options are available, he said, “because as we move into learning to live with COVID, we need to know what we should be doing to keep ourselves and our loved ones [safe].”

Raquel Torres is the San Antonio Report's breaking news reporter. She previously worked at the Tyler Morning Telegraph and is a 2020 graduate of Stephen F. Austin State University.