Estimation of Public Compliance

with COVID-19 Prevention Standard

Operating Procedures Through
a Mathematical Model

Norazaliza Mohd Jamil and Balvinder Singh Gill

Abstract Despite the enforcement of control plan and preventive measures, the
transmission of COVID-19 is still ongoing and yet to be contained successfully.
Hence, this study aimed to determine the level of compliance of the public with the
standard operating procedures for COVID-19 prevention in Malaysia. A compart-
mental model with new formulations of timely dependent epidemiological parameter
for COVID-19 outbreaks was developed. The model, consisting of ordinary differen-
tial equations, was solved by the 4th order Runge–Kutta method. The model repre-
sentation is in the form of graphical user interface (GUI) built in MATLAB. The
estimation of the level of compliance of the population with the control measures
was done by fitting the model curve to the actual data in the GUI. The result shows
that the current compliance level of the public to the control measures is at an unsat-
isfactory level that leads to repeated lockdown. The compliance level estimation is
important to policymakers and health officials as they can infer the effectiveness
of intervention strategies. Additionally, this study revealed how individual respon-
sibility to adherence the control measures will affects the number of cases. Further
action to increase public compliance to a satisfactory level is required to halt the
pandemic successfully.

Keywords Compliance · Modelling and simulation · COVID-19 · Malaysia ·

Compartmental model

N. M. Jamil (B)
Centre for Mathematical Sciences, College of Computing and Applied Sciences, Universiti
Malaysia Pahang, Lebuhraya Tun Razak, 26300 Gambang, Kuantan, Pahang, Malaysia
e-mail: norazaliza@ump.edu.my
B. S. Gill
Institute for Medical Research (IMR), Ministry of Health Malaysia, 50588 Kuala Lumpur,
Malaysia
e-mail: drbsgill@moh.gov.my

© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022 49
S.-L. Peng et al. (eds.), Proceedings of 2nd International Conference on Mathematical
Modeling and Computational Science, Advances in Intelligent Systems
and Computing 1422, https://doi.org/10.1007/978-981-19-0182-9_5
50 N. M. Jamil and B. S. Gill

1 Introduction

COVID-19 first discovered in Wuhan, China in December 2019 was subsequently

affirmed a pandemic by the World Health Organization (WHO) on 11 March 2020
[1]. More than 124 million cases have been reported with over 2.7 million deaths
worldwide [2]. In Malaysia, the first wave of COVID-19 resulted from imported
cases on 25 January 2020 with a total of 22 cases [3]. A larger second wave started,
following a 4-day mass gathering event at Sri Petaling, Kuala Lumpur on 27 February
2021 [4]. This resulted in the largest COVID-19 cluster during the second wave with
3375 confirmed cases with 34 deaths reported [5, 6]. Currently, Malaysia is facing
the third COVID-19 wave which started after the Sabah state electoral process on 26
September 2020 [7].
Understanding the evolving epidemiology of COVID-19 during this pandemic
may better inform prevention and control policies, hence it is important to systemat-
ically characterise the epidemiology of COVID-19 [8]. Epidemiological indicators,
estimated via a surveillance system, are critical in developing timely interventions.
However, constraints in the surveillance process, especially in the developing world,
have meant these epidemiological indicators are inadequately or not estimated [9].
Whilst indicators such as incidence rate, growth rate and doubling time may be
useful for outbreak monitoring, it is unable to estimate compliance level of the public
towards the control measures. Estimating compliance level during an epidemic is
important as it provides an aggregated measure of the effectiveness of these control
measures. Therefore, compliance levels are effective and useful indicators for control
purposes.
Malaysia implemented the first national lockdown, namely Movement Control
Order (MCO) on 18 March 2020. The second nationwide lockdown known as MCO
2.0 was imposed on 13 January 2021. The increasing number of cases have forced the
government to enforce MCO 3.0 on 12 May 2021. The Ministry of Health (MoH)
introduced the standard operating procedures (SOPs) based on avoiding crowded
places, confined spaces and close conservation to slow down the propagation of the
infection. The public must exercise physical distancing and practise the 3Ws (wash
hands, wear a facemask and warn self and others). In spite of the rules and efforts
exerted by the government, the spread of the disease was perceived to be growing
occasionally, which required the implementation of repeated lockdowns. One reason
for this can be attributed to the inadequate compliance of the public towards the
SOPs.
As cases of COVID-19 increase in Malaysia, there was a need to develop a proce-
dure to determine the level of compliance. Hence, this paper aims to develop an
automated interactive visual component to generate the outbreak progression of
COVID-19 based on compliance level. In this paper, we aim to estimate the SOPs
compliance level in Malaysia using a compartmental SIRD model and to develop
a GUI to automate the model outputs. Findings from this study will inform poli-
cymakers and health officials and assist them infer the effectiveness of intervention
Estimation of Public Compliance with COVID-19 Prevention … 51

strategies. In addition, this study will increase public awareness about their individual
responsibility and role in fighting against the pandemic.

2 Mathematical Model

We established a new mathematical formulation to describe the spread of the disease

in a population using the SIRD compartmental model originated from the work of
Kermack and McKendrick in 1927 [10]. This compartmental model comprises of
four groups which are S (susceptible), I (infectious), R (recovered) and D (death).
Essentially, S(t) is the total number of individuals at risk of being infected by the
disease measured from day 1 to day t. I (t) is the total number of individuals who have
been infected and can spread the disease to group S from day 1 to day t. The total
number of individuals who have been infected with the disease and have recovered
from the illness from day 1 to day t is labelled as R(t). The final category is D(t),
which denotes the total number of people who have died from the disease and counted
from day 1 to day t. The model was developed based on the following assumptions.
(a) The total population is constant whilst the natural birth and death rates are
ignored
(b) The disease is spread by infected individuals coming into close contact with
susceptible individuals (the sporadic case is not considered).
A set of ordinary differential equations formulates the mathematical model as
follows,

dS I
= −β(t) S (1)
dt N
dI I
= β(t) S − γ (t)I − μ(t)I (2)
dt N
dR
= γ (t)I (3)
dt
dD
= μ(t)I (4)
dt
where β(t) is the function of infection rate of the disease, γ (t) is the function of
recovery rate and μ(t) is the function of death rate. N is the constant total population
which can be formulated as

N = S(t) + I (t) + R(t) + D(t) (5)

Constant values of infection, recovery and death rates would only produce the
result of the model for one wave of the outbreak. Hence, to model multiple waves of
52 N. M. Jamil and B. S. Gill

outbreaks in a single formulation and initial value, we used the piecewise functions
in formulating the functions of epidemiological parameters. The piecewise functions
divide the time intervals based on the intervention measures implemented. Different
functions will be adopted to the time prior to lockdown, during the lockdown and
the reopening period after the lockdown. Assuming tlock and tlock 2 be the day when
a country imposed the first and second lockdown, respectively. Whilst tlift and tlift2
indicate the day of easing of lockdown rules after the first and second lockdown,
respectively. At the time of the writing, Malaysia is currently in MCO 3.0, and the
future case trends are unknown, hence our model only considered the time for MCO
1.0 and MCO 2.0. In this work, new formulations for time-dependent epidemiological
function parameters, β(t), γ (t) and μ(t), were constructed as follows.
MCO 1.0

γ (t) = γ1 , μ(t) = μ1 (6)

⎧
⎪
⎪ β,   t < tlock
⎨ 1 (t−tlock )
β(t) = β1 exp − τβ1
, tlock ≤ t < tlift (7)
⎪  
⎪
⎩ (1 − r)β1 + rβ1 exp − (t−tlock ) , t ≥ tlift
τβ1

MCO 2.0

γ (t) = γ1 , μ(t) = μ1 (8)

⎧
⎪
⎪ β1 ,   t < tlock
⎪
⎪
⎪
⎪ β1 exp − τβ1 ,(t−tlock )
tlock ≤ t < tlift
⎪
⎪  
⎨ (tlift −tlock )
β(t) = β
2 (t − tlift ) + β1 exp −
τβ1
,
  
tlift ≤ t < tlock2
⎪
⎪
⎪
⎪ β2 (tlock2 − tlift ) + β1 exp − (tliftτ−tβ1lock ) exp − (t−tτβ2
lock2 )
, tlock2 ≤ t < tlift2
⎪
⎪  
⎪
⎪
⎩ (1 − r)β1 + rβ1 exp − τβ1 , (t−tlock )
t ≥ tlift2
(9)

The recovery and death rates depend on the disease and the individual and do
not vary as a function of t and the lockdown. Specifically, 1/γ is the infectious
period. Hence, the recovery rate, γ (t) and death rate, μ(t) were assumed to be a
constant value as in Eqs. (6) and (8). The infection rate depends on the rate of
contact between infected and susceptible individuals. Lockdown is a promising way
to reduce the contact rate between individuals. Hence, the infection rate is formulated
as a time-dependent function.
Factors for intervention measures, such as lockdown, social distancing, quaran-
tine, healthcare system, the percentage of people who follow the SOPs, hospitali-
sation of the infected individuals and treatment were considered in formulating the
Estimation of Public Compliance with COVID-19 Prevention … 53

infection rate. Equations (7) and (9) formulated the infection rate for MCO 1.0 and
MCO 2.0, respectively.
At the start of the outbreak (t < tlock ), the population was highly mobile, and
the infection rate was assumed to be constant, β1 . When the first lockdown was
introduced (tlock ≤ t < tlift ), the infection rate decayed due to restricted movement
of the population and social distancing practices. This behaviour was described by
an exponential function in Eq. (7) with τβ1 as the characteristic time of transmission
during lockdown 1.
To measure the SOP compliance level after MCO 1.0 (t ≥ tlift ), a new parameter r
which indicates the fraction of compliance of the public to the SOPs was introduced.
In other words, r is the percentage of the public who follow the SOPs, even after
the lockdown was lifted. If 0% of public compliance level (r = 0), the infection
rate followed the trend at the beginning of the outbreak when there was no lockdown
implemented. If 100% of public compliance level (r = 1), the infection rate followed
the trend when the lockdown was implemented.
The mathematical model for MCO 2.0 in Eq. (9) followed the same manner
as in the model for MCO 1.0 by extending the formulation for tlift ≤ t < tlock2 .
During the second lockdown (tlock2 ≤ t < tlift2 ), the infection rate was decreased,
and it was described by an exponential function with τβ2 as the characteristic time of
transmission during lockdown 2. The behaviour of infection rate after the lockdown
was lifted is depended on the percentage of people who followed the SOPs. We used
MCO 1.0 as a reference to measure the compliance level after MCO 2.0 (t ≥ tlift2 ),
hence the infection rate was similar to formulation for t ≥ tlift .
A 4th order Runge–Kutta method coded in MATLAB was used to numerically
solve the mathematical model. A parameter fitting technique called Nelder-Mead
algorithm was employed to find the value of all unknown parameters β1 , β2 , γ1 , μ1 ,
τβ1 and τβ2 . The Nelder-Mead algorithm performed an adaptive process that searched
for points to satisfy function minimization that provides the best-fit trajectory of the
model with the actual epidemic data.
A graphical user interface (GUI) simulation tool for COVID-19 outbreaks was
developed in MATLAB. At the beginning of the programming process, the user is
required to fill two input boxes as shown in Figs. 1and 2 by entering the lockdown
easing date and the percentage of people who follow the SOPs. The two parame-
ters are activated with a push-button labelled ‘run the simulator’ resulting in two
projection graphs appearing. The first graph will show the value of the effective
reproduction number, and the second graph visualizes the number of active cases of
COVID-19. The black square symbol plots the actual observed-case numbers.

3 Results and Discussion

The dynamics of the COVID-19 outbreak in Malaysia were investigated by applying

this new developed model and the GUI interface. The total population of Malaysia
was assumed to be constant (N = 32 million). The initial conditions I (0) = 3,
54 N. M. Jamil and B. S. Gill

Fig. 1 Compliance level estimation after MCO 1.0 with 40% compliance (fit the model curve to
the data)

Fig. 2 Compliance level estimation after MCO 2.0 with 55% compliance (fit the model curve to
the data)
Estimation of Public Compliance with COVID-19 Prevention … 55

Table 1 Parameter values

Parameter Value
β1 0.146556534767631
β2 0.000854504525536
γ1 0.051036351893306
μ1 0.000668710997547
τβ1 38.321191281261029
τβ2 16.621055127092735

S(0) = N − I (0) − R(0) − D(0) and R(0) = D(0) = 0 were obtained from the
actual data reflecting the first case of COVID-19 detected in Malaysia which was
on 25th January 2020 (day 1). Denoting tlock as the day when Malaysia imposed the
first lockdown termed as the Movement Control Order (MCO) on 18 March 2020
(day 54). tlift is described as the lifting time that refers to the date 22 July 2020 when
schools in Malaysia was reopened (day 180). The second lockdown known as MCO
2.0 was then implemented on 13 January 2021 (day 355).
Daily COVID-19 case data for Malaysia are from the Crisis Preparedness and
Response Centre (CPRC) of the Malaysian Ministry of Health and from press releases
on the official Ministry of Health (MOH) Website at http://www.moh.gov.my/. The
Nelder-Mead algorithm estimated the six unknown parameters by fitting the model
to actual COVID-19 case data during the period between 25th January 2020 and 31st
March 2021. Table 1 lists the resulting parameter values.
Health authorities are facing enormous challenges in controlling the spread of
COVID-19. The introduction of non-pharmaceutical control measures such as travel
restrictions, physical distancing, face masks, hand hygiene, quarantine and isola-
tion, aims to decrease the effective reproduction number, thus slowing the spread of
COVID-19 and sustains the healthcare delivery systems. However, individuals are
required to adopt new behaviours and required to be compliant to the prescribed SOPs
stringently for prolonged durations, which are affecting the social and economic well-
being of the population. This balance between lives and livelihood is crucial to the
success in combating the COVID-19 pandemic.
Public compliance with the control measures proposed by the authorities is a
crucial factor in controlling the disease. This situation requires in the ability to
measure the levels of SOP compliance of the public. Past studies have attempted
measuring the compliance levels of the public to the SOPs with mixed results. Kayrite
et al. [11] measured the compliance level of the people in Ethiopia by investigating
food and drink establishments via face-to-face interviews. Plohl and Musil [12] used
525 online surveys and developed a multivariate model to identify different responses
to COVID-19 prevention compliance.
In this study, we used a novel method to estimate the time-varying epidemiological
parameters to the compartmental SIRD model, wherein we explored the effect of SOP
compliance levels on the dynamics of the disease outbreak in Malaysia. The model
proposed in our study is represented in the form of a GUI, and in addition, the degree
of compliance can be estimated by fitting the model curve to the data.
56 N. M. Jamil and B. S. Gill

Malaysia launched its first national lockdown, called the Movement Control Order
(MCO) on 18 March 2020. Interstate and interdistrict travel were not allowed. In
Fig. 1, the result shows that a 40% compliance fits well to the data. This determines
that only 40% of the public adheres to the SOPs. As described by this model, the
strict MCO 1.0 had successfully flattened the curve, however, poor compliance to the
SOPs by the public after the easing of the movement restrictions led to an increased
number of positive COVID-19 cases. The mass gathering during the Sabah state
elections on 26 September 2020 can be attributed as a leading cause in the sharp rise
of COVID-19 cases in Malaysia [13].
To address the worsening surge of COVID-19 cases, Malaysia imposed its second
nationwide lockdown, called Movement Control Order 2.0 on 13 January 2021. The
implementation of MCO 2.0 had successfully decreased the number of COVID-
19 cases at an early stage. After the MCO 2.0 was lifted on 4 March 2021, the
observed data showed a subsequent increase in caseloads in early April 2021, indi-
cating a decrease in compliance to the SOPs. As shown in Fig. 2, we fitted the model
curve to the actual data in the GUI and concluded that only 55% SOP compliance
was achieved. In this simulation, we set the lockdown easing date on 08/03/2021,
marking the reopening of primary schools in Malaysia. The model measured that
only 55% of the public followed the SOPs after the relaxation of MCO 2.0 which
resulted in the observed rise in daily cases. With the introduction of new variants with
higher infection rates and the lack of SOP compliance, the government was forced to
introduce MCO 3.0 on 12 May 2021, to curb the rising number of COVID-19 cases.
These findings disclosed that the overall compliance level of the public to the SOPs
was inadequate, which lead to the introduction of repeated lockdowns. Authorities
took action over non-compliance with the SOPs such as failure of individuals to
comply with physical distancing measures, over-crowding, not registering movement
details, not complying with temperature screening and travel restrictions.
Non-compliance to the SOPs may occur due to various factors such as lack of
self-discipline and awareness of the public. Willingness to comply depends on the
individuals’ capacity to obey the rules, education, moral support and social norms
[14]. Individuals who live in poverty and have economic constraints may not be
unable or unwilling to adhere to the SOPs due to lack of income [15]. In addition,
workers who live in crowded dormitories may have difficulty complying with the
prevention guidelines. Public compliance towards these SOPs are crucial to curb the
COVID-19 pandemic.

4 Conclusion

This paper developed a novel approach to estimate the public compliance in Malaysia
with COVID-19 prevention standard operating procedures by using a mathemat-
ical model. In addition, a novel formulation for the time-dependent epidemiological
parameters for the SIRD model was also proposed, and a graphical user interface
Estimation of Public Compliance with COVID-19 Prevention … 57

(GUI) was created. The GUI provides a user-friendly interface to assist in the simu-
lation of the effect of SOPs compliance on the spread of the outbreak. The overall
results show that the compliance level to the COVID-19 prevention SOPs in Malaysia
is inadequate, resulting in the implementation of repeated lockdowns. This study
revealed the importance of individual responsibility to the adherence to SOPs as a
crucial factor to win the battle against the pandemic in Malaysia. Finally, in regards
to the modified SIRD model outcome, this study showed that the proposed model
is able to measure the SOP compliance levels during this pandemic. Since, there
is limited relevant research on measuring the SOP compliance level in Malaysia;
hence, this study provides significant findings and knowledge on the dynamics of
the COVID-19 pandemic in Malaysia.

Acknowledgements We would like to thank the Director General of Health Malaysia for his
permission to publish this article.

Funding This research was funded by a grant from Universiti Malaysia Pahang, Internal Grant
RDU 210329. (Ref: UMP.05/26.10/03/RDU210329).

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