Fig. 5: Impact of test-and-treat in a high-income country (Netherlands) with wide availability of over-the-counter-self-tests.

No restrictions on access to symptomatic testing at clinics (i.e., all symptomatic individuals who sought testing at clinics would receive one if in stock) and high-risk household contacts of test-positive individuals are not tested. Over-the-counter antigen rapid diagnostic tests (Ag-RDTs) are assumed to be widely available with unlimited stocks. As such, we assumed that only 10% of symptomatic individuals would seek clinical testing directly while 80% of those who opted not to seek clinic-provided testing would perform self-testing using over-the-counter Ag-RDTs. All high-risk individuals who tested positive through self-testing would seek reflexive testing at clinics on the same day. All eligible high-risk individuals (i.e., ≥60 years of age or an adult ≥18 years with a relevant comorbidity) who tested positive at clinics, either directly or through reflexive testing, were given a course of oral antivirals. Line plots (left y axis) show the mean percentage change (standard deviation denoted by error bars; n = 5 independent simulations) in a total infections, b severe cases and c deaths relative to no distribution of antivirals under different clinical testing rates (different shades of color) after a 90-day SARS-CoV-2 epidemic wave in a population of 1,000,000 individuals with 80% vaccination coverage for different epidemic intensities (measured by the initial effective reproduction number (R_e); x axis). Bar plots (right y axis) show the number of severe cases in each corresponding scenario. The dotted outline of each bar shows the number of severe cases of each scenario when no antivirals were distributed.