Stepwise Markov model: a good method for forecasting mechanical ventilator crisis in COVID-19 pandemic

Abstract Objectives One important variable influencing day-to-day decisions in COVID-19 pandemic has been an impending shortage of mechanical ventilators due to the large number of people that become infected with the virus due to its high contagiousness. We developed a stepwise Markov model (a) to make a short-term prediction of the number of patients on ventilator, and (b) to determine a possible date for a ventilator crisis. Methods Starting with the exponential curve of new cases in the previous 14 days, we calculated a Markov model every 5 days thereafter, resulting in a daily estimate of patients on ventilator for the following 25 days, which we compared with the daily number of devices in use to predict a date for ventilator crisis. Results During the modeled period, the observed and predicted Markov curves of patients on ventilator were very similar, a finding confirmed by both linear regression (r=0.984; p<0.0001) and the near coincidence with the identity line. Our model estimated ventilator shortage in Chile for June 1st, if the number of devices had remained stable. However, the crisis did not occur due to acquisition of new ventilators by the Ministry of Health. Conclusions In Chile as in many other countries experiencing several asynchronous local peaks of COVID-19, the stepwise Markov model could become a useful tool for predicting the date of mechanical ventilator crisis. We propose that our model could help health authorities to: (a) establish a better ventilator distribution strategy and (b) be ready to reinstate restrictions only when necessary so as not to paralyze the economy as much.