Coronavirus: no walk in the park


A sunny weekend is forecast, with predictions of a pleasantly warm Sunday. As we run towards the end of the second week of lockdown, therefore, the temptation to ignore health secretary Hancock's "instruction" and make the most of the good weather must be overpowering.

That tension exists over the continuation of the lockdown policy is borne out by the Telegraph, as some ministers argue for the measures to be lifted "sooner rather than later".

One minister goes so far as to argue that government would come under "increased political pressure" to lift the lockdown when parliament reopens on 21 April, and that presupposes that it has not already been confronted by a mutiny led by stir-crazy parents at their wit's end after running out of ideas to deal with bored and fractious children.

But, there are troubles lying in store for us, according to Anthony Costello (our former WHO man).

He has been speaking to a senior international epidemic expert who tells him that: "You can stop contact tracing in the hotspots, but when you lift the lockdown, everywhere at the same time, you'll face a problem: the virus will come back. New hotspots will form".

Actually, I've been thinking about this very thing, all in the context of the more general predictions about this epidemic, where modelling estimates suggested that the UK could suffer 750,000 additional deaths over the course of a pandemic, with local planners having to cope with up to 210,000 to 315,000 additional deaths over a 15 week period and perhaps half of these over three weeks at the height of the epidemic.

On reflection, if you accept that we don't have a single outbreak but many, with foci all over the country and at different stages of development, I can't see this frightening timescale being realised.

For a start, because the case and mortality totals – currently standing at 38,168 cases and 3,605 hospital recorded deaths – are largely fuelled by just a few hotspots, the population at risk to exponential phase outbreaks is not the 60 million plus of the entire nation. It could be a very much smaller figure of around ten million.

That means we're not going to see the massive figures predicted – not yet, anyway, and even then not at the speed predicted. The hotspots, as long as the lockdown is maintained, will eventually burn out as the virus is robbed of fresh meat, rather in the manner of a wildfire which has been contained by firebreaks.

The "firebreak" equivalent is the lockdown, which has put a lid on much of the spread. Thus, the opportunity for infection to pass from the London hotspot to, say, York, is fairly limited. But once the lockdown is lifted - as it must be in the not too distant future - movement throughout the country will be resumed. New outbreaks will crop up and existing small-scale incidents will be refreshed.

If we have started to see a downturn in the rate of new cases, which the CMO predicts might happen within two to three weeks, it will not last. We will be looking at a newly-invigorated epidemic and we'll be back where we started.

Costello's man thus argues that, to stop the epidemic, we must have a community programme for case detection and contact tracing. Otherwise, he says, "you won’t find the virus until it's too late".

Enter, at this point, Richard Vize, who complains that local authority activities to tackle the epidemic are being hampered by "central micromanagement". Ministers, he says, persist in the fantasy that everything works best when it is run from the centre.

The tensions aren't about money, he adds, but about communication and coordination. There have been delays, confusion and aborted work, such as changes of policy about where central and local government responsibilities lie, while public health directors are frustrated at being excluded from key communications and the development of guidance by NHS England and government departments.

As the message is that much more should be done by local authorities, the timing of a letter from Steve Battersby, Vice-president of the Chartered Institute of Environmental Health, couldn't be better.

Despite the years of austerity, he writes, there are resources in local government that we have also failed to use. There have been environmental health officers (EHOs) up and down the country desperate to help their public health colleagues – for example, with tracing contacts after testing (if there had been any).

They would also have been more effective at getting messages out to the public, particularly those most vulnerable or living in multi-occupied houses. Many EHOs have been left twiddling their thumbs for too long when their whole reason to exist is to protect public health.

You read it here first, of course. And another interesting, if familiar view comes from Michael Waterson at Warwick University. He says that it is a common view that the British government moved too late to institute a policy of testing everyone who has had recent contact with known coronavirus cases.

However, he tells us, there are several English local authorities in which there are fewer than five known cases and case density in the local population is very low. Using the most recent current figures, these include Hull, Blackburn, Stoke-on-Trent, Telford, Gateshead, Middlesbrough, Redcar and Darlington.

Testing all those who have had contact with the known cases in these areas should be a strictly limited task. Once done, subject to movement restrictions in and out, productive activity in these areas can commence or recommence, engineering facilities put to use in producing items in critically short supply – and they can once again, after many years, become an engine of growth.

With that low incidence, the monitoring of cases is easily manageable, especially if known and under-used resources such as EHOs were used, which begs the question as to why the government did not embark on an extensive community testing programme, tracing and testing cases and contacts.

Typically, the media has turned the lack of testing into a political scandal, and the fringe media is luxuriating in ever-more lurid conspiracy theories, but I'm afraid we will have to be content with that reliable old workhorse for an explanation – government (and professional) incompetence.

So far, I have managed to review government pandemic planning documents going back to 2005, such as this and this, both under Labour health secretaries, respectively John Reid and Patricia Hewitt.

Then we had this interesting document in 2006 – still under Labour's Patricia Hewitt – which gave advice to businesses, retailing the "key planning assumption" that, "during a flu pandemic, the government's overall aim will be to encourage people to carry on as normal, as far as possible". When 15 years later, we say the Johnson administration initially attempt the same policy, few would have thought that he shared it with the Blair government.

And since then, we have had an international strategy and a national framework in 2007, framed under Gordon Brown, together with an analysis of the science base for an overarching government strategy, which spanned Blair's and Brown's tenures in office.

This then brings us to the 2011 Preparedness Strategy, brought into being under Cameron's coalition government, as was the 2014 response plan and strategic framework.

A common thread running through all these plans was the limited use of community testing. It is limited to monitoring the first stage of the epidemic to establish when community spread had occurred. There is no provision in any of the plans for an extensive "trace and test" programme. In all cases the government relies for the resolution of the epidemic on the development of a vaccine, using the hospital services to hold down the death rate (mitigation) until it comes available.

In other words, while many different governments have had an input into planning the pandemic response, the short straw has gone to the Johnson administration, which has found that standing back and allowing the casualties to mount - the "bring out your dead" policy, while awaiting the cavalry is not politically tenable.

Desperately trying to deflect the political flak from their favoured son, we have serial latter day experts like Jeremy Warner and the ever-pompous Charles Moore blaming the bureaucrats, but the fact is that we are suffering from decades of inadequate policy-making.

And sadly for Johnson and his fellow ministers, they are finding that changing policy on the hoof is no walk in the park - which perhaps explains why Hancock is so keen to deprive us of that pleasure this weekend.

Richard North 04/04/2020 link

Coronavirus: the killer with a benign face


I am not sure I want to be part of a country where the prime minister (any prime minister) is delivering daily broadcasts to the nation, which then become a central part of our lives upon which so much hangs. But it is a singularly cruel deity (or one with a magnificently warped sense of humour) which foists upon me in particular a man who I detest so much that it is quite unpleasant merely to watch him.

Yesterday's press conference, therefore, offered the usual dose of torture (mercifully absent on Saturday), when the Great Leader told us why the government was taking its "unprecedented steps".

The reason "of course", he said, was that "we have to slow the spread of the disease and to save thousands of lives", at which point we entered something of a fairy-tale land - the one in which we actually have a government which knows what it is doing.

Thus today, said the Great Leader, "we've come to the stage of our plan that I advertised at the outset, when we first set out plan of the UK government, when we now have to take special steps to protect the particularly vulnerable".

Up to a point, Lord Copper, one might say, but reference to this fabled plan does not exactly support Johnson's claim.

Far from seeking to take the vulnerable out of the infection loop, it actually noted that "there could well be an increase in deaths arising from the outbreak, particularly amongst vulnerable and elderly groups". One was supposed to take comfort from the alertness of the beneficent UK Government and Devolved Administrations. These would "provide advice for local authorities on dealing with this challenge".

Nevertheless, Johnson told the assembled hacks that "You'll remember when I said the moment would come when we needed to shield those with serious conditions. There are probably about one-and-a-half million in all", but this is notably absent from The Plan. It was raised on 15 March, after the government had "faced pressure to do more to tackle the epidemic".

In response, Downing Street had said it would continue to be guided by its medical experts. Its Scientific Advisory Group for Emergencies (Sage) had thus listed "shielding the vulnerable" and "household isolation" as the next steps to tackle the spread of the virus.

However, all is well says Johnson. "This shielding will do more than any other single measure that we are setting out to save life. That is what we want to do. Also to reduce infection and to slow the spread of the disease".

One can hardly avoid wondering, though, why – if this shielding is such a potent weapon - it wasn't specifically identified earlier. But then, if we are to believe the Sunday Times, young Master Cummings had originally convinced the Great Leader that slaughtering the sick and elderly was the way to go.

In a hotly disputed passage, dismissed as a "defamatory fabrication", the ST has it that Cummings "became convinced that Britain would be better able to resist a lethal second wave of the disease next winter "if the CMO's prediction that 60 to 80 percent of the population became infected was right and the UK developed "herd immunity".

Thus, at a private engagement at the end of February, the "career psychopath" outlined the government's strategy. Those present say it was "herd immunity, protect the economy and if that means some pensioners die, too bad".

Something of this "bring out your dead" policy, was evident even without the inside track, although we had pointed the way to a shielding strategy on 4 March when we suggested that:
Where most of the young(er) victims are only mildly affected, perhaps the best thing to do would be to isolate the "at risk" groups and then let the virus rip through the community until herd immunity reaches about 80 percent and the epidemic peters out naturally.
Deliberately or otherwise, this seems precisely the strategy on which the government is now embarking – a strategy of last resort as its half-hearted measures are unlikely to have a decisive effect.

This clears the way for a timely intervention from Peter Hitchens, who asks: "Is shutting down Britain – with unprecedented curbs on ancient liberties – REALLY the best answer?"

He is not wrong to ask that question – it should be asked. And in getting to that point, after recounting an unfortunate experience with a medical doctor, he asserts that, "A mere title, a white coat, a smooth manner, a winning way with long words and technical jargon, will never again be enough for me". One could not disagree with that.

As to the number crunchers of the Imperial College in London, about whom we have been less than complimentary, Hitchens has this to say:
In a pungent letter to The Times last week, a leading vet, Dick Sibley, cast doubt on the brilliance of the Imperial College scientists, saying that his heart sank when he learned they were advising the Government. Calling them a "team of doom-mongers", he said their advice on the 2001 foot-and-mouth outbreak "led to what I believe to be the unnecessary slaughter of millions of healthy cattle and sheep" until they were overruled by the then Chief Scientific Adviser, Sir David King.
In principle, I could hardly disagree with that and I can only agree with Hitchens when he adds that: "I despair that so many in the commentariat and politics obediently accept what they are being told. I have lived long enough, and travelled far enough, to know that authority is often wrong and cannot always be trusted".

As to whether all these restrictions are necessary, I have already articulated my view that, if the government had got to grips with "test and trace", they would not have been necessary. Probably now, because of earlier government failures, they are necessary, but I don't believe they are sufficient - we still need an aggressive programme of "test and trace".

Overall though, I think Hichens fails to understand the distinction between absolute mortality and mortality rate. Coronavirus produces a relatively low death rate but, because of its infectivity and the disease profile, it is capable of killing far more people (absolute mortality) than a less virulent organism.

The reason why this virus is so dangerous is exactly because of its relatively low virulence, causing only mild illness in the majority of the population that it infects. Ebola, by contrast, killed as many as 90 percent of the people it touched, so it never spread. It killed off its victims too fast.

The same goes for the clinically indistinguishable Green Monkey (Marburg) Disease which is so deadly that investigators in the early days were stumbling on whole troops of dead monkeys in the forests of Equatorial Africa, with no spread to their neighbours.

By contrast, coronavirus is our worst nightmare. The high proportion of asymptomatic infections and mild illness means that it can spread undetected throughout the population to become a huge reservoir of infection, and then pass to the vulnerable whom it kills.

Furthermore, because the mortality rate is so low, many people under-estimate the danger, mainly because – like Hitchens - they don't understand the difference between mortality rate and absolute mortality.

This virus may kill a smaller proportion of the population it infects than Ebola, and the less deadly influenza virus, but because it is so supremely efficient at spreading, it will infect vastly more people – potentially running to millions unless checked. In terms of absolute numbers, it could kill far more people than ostensibly more dangerous viruses.

But we cannot rely on this virus only infecting the sick and elderly. There are clear indications of a dose-response, which probably works both ways.

Low doses spread via air conditioning systems, or airborne transmission from pre-symptomatic carriers, may result in lower infection rates and more benign outcomes for most sufferers than heavy or multiple doses passed directly from symptomatic patients - putting medical personnel particularly at risk

There is no good argument, therefore, to support the idea that we should take a relaxed approach to controlling this disease. Should we be forced to take such stringent measures as a complete lockdown, this could be taken in part as a reflection of the incompetence of the authorities in dealing with the threat, but that doesn't mean they are unnecessary.

This is a killer with a benign face, and all the more dangerous for that.

Richard North 23/03/2020 link

Coronavirus: bring out your dead


In the days before one of the many reorganisations of the NHS, investigation of notifiable diseases was a local authority function, and public health inspectors (later to become environmental health officers) were often in the front line.

As a student public health inspector, back in the early '70s, I received formal training in the theory of epidemiology and the control of communicable diseases - more intensive than medical doctors received. I then topped up my knowledge by being involved in the practicalities of real-life outbreak investigation and control.

Studying for my PhD on the public sector investigation of salmonella food poisoning didn't hurt. Not only did I learn a lot more about epidemiology, I also gained what was probably a unique insight into how the infectious disease control system in the UK worked, and a fair idea of some foreign systems, as I used those as a comparator.

I was involved practically and politically in the Salmonella and Listeria scares of the '80s and '90s, and then in BSE/CJD, with E. coli O157 and also the Foot and Mouth outbreak of 2001, writing extensively about all these episodes, including a short history of the Aberdeen Typhoid Outbreak. I also worked in hospitals on cross infection programmes, doing field trials for a startup company which had invented an innovative disinfection system.

Thus, I think I have a reasonable appreciation of control mechanisms relating to communicable diseases, and have a better than average understanding of public health politics – at a national and European level.

As a result, I have to say that I have rarely been impressed with official endeavours to control disease, and the political treatment of epidemics has, in my view, generally been lamentable.

One of the most notable in recent times was the 2001 Foot & Mouth outbreak where – in the considered view of many including myself - millions of animals were needlessly destroyed (much of the destruction directed by epidemiologists using unproven computer models), leading to obscenities such as the mass burial of half-a-million sheep in specially dug pits at Great Orton airfield in Cumbria – most of the animals having been healthy before slaughter.

I took the photograph illustrated at the height of the outbreak, with myself and Pete perched precariously in a cherry-picker which an enterprising farmer was hiring out to journalists and their snappers, as one of the few ways they could get to see over the boundary screens, and find out what was going on. And it is only by seeing that one can begin to appreciate the scale of the slaughter.

And here we are nearly twenty years later, it seems, with the government planning to repeat the same ghastly process, presiding over another great but avoidable carnage. This time, though, the victims are to be human, some half-a-million of (mainly) the elderly and the sick.

The progenitor of this obscenity is prime minister Johnson, aided and abetted by his two stooges, chief medical officer for England, Chris Whitty, and Patrick Vallance, chief scientific adviser, together with a cast of unknowns, undoubtedly all under the malign influence of the Rasputin-like figure of Dominic Cummings.

Collectively, this group is embarked on a strategy for dealing with the current epidemic of Covid-19, in what could be described as a unique and innovative way or, more prosaically, by adopting such staggeringly inept methodology that it only just falls short of premeditated mass murder.

In order to set the background, one must first look at the standard, and well-rehearsed procedure for dealing with outbreaks of infectious disease – and especially those where vaccination is not available, as is the case here.

The first and urgent need in such situations is the rapid identification (and confirmation) of the sources of infection. In this case, the primary sources (barring some zoonotic source which is presumably long gone), are human beings.

These must be isolated from the population until they have ceased to shed the infective virus. But, bearing in mind that these people may have infected others before being removed from the infection chain, one must carry out a rapid process of contact tracing, with testing to establish whether they have been infected, and isolation of those who are infective.

Next, one must neutralise the routes of infection. In this case there are three: direct contact with infected persons (who may or may not be showing signs of infection), contact with surfaces contaminated by infected persons, and by airborne spread.

Much of this is achieved by isolating actual and potential sources of infection. Otherwise, measures include minimising human contact – which will mean banning public gatherings – the use of face masks, concurrent cleaning and disinfection of potentially contaminated surfaces, the use of barrier clothing and enhanced personal hygiene.

As we have seen in Wuhan and elsewhere, all these things, pursued rapidly and aggressively, will bring an epidemic under control, even if the emphasis on which specific controls to use may vary from place to place.

But, rather than adopt the tried and tested methodology, Johnson and his team have chosen to step outside the established framework and rely on minimal intervention. Instead, the government has put its faith initially in the single control of enhanced hand washing – on the flawed assumption that the primary mode of spread is direct contact with an infected person or contaminated surface.

Only latterly has the government decided to move to voluntary, self-isolation of all people with flu-like symptoms - a fever above 37.8 C or a persistent cough - for seven days (less than half the period of potential infectivity), with no testing and no contact-tracing.

Not in any conceivable way can the measures proposed succeed in bringing this epidemic under control, with cases now at 798, up from 590 the day before – the cases doubling every four days. It is extremely debatable whether this can even delay the rise in cases, aiming for what is called "flattening the curve" – something never tried before in the entire history of public health.

And when finally, the government has moved to banning mass gatherings, this has only happened because so many sports and other private enterprises have taken matters into their own hands, making this a significant U-turn by Downing Street.

Latterly though we discover from chief scientific adviser Vallance that the only aim is to reduce the peak of the epidemic, rather than bring it under control. This has the theoretical but unproven aim of reducing pressure on healthcare systems.

Yet we are given to understand that this is aimed at protecting the most vulnerable people while the virus spreads through the general population. The approach, we are told, "would help build up herd immunity as people recover from the disease and become immune, reducing transmission".

Yet, in the first instance, since there are no official moves physically to distance vulnerable people from potential sources of infection, it is difficult to see how government policy can be construed as protecting them. At that level, what Vallance is saying simply doesn't make sense.

As to building up "herd immunity", in the context of modern techniques for controlling epidemics caused by novel pathogens (for which there are no vaccines), this is almost a throwback to the Middle Ages.

Without vaccination, in order to achieve herd immunity, one relies on the response of people exposed to the new pathogen: some get ill and die. Others get ill and recover, and thereby acquire a level of immunity. Others who are exposed don't get ill but nevertheless acquire some immunity. Under some circumstances, mothers pass on their immunity to their children.

At a point where the immunity of the survivors reaches a certain level, the pathogen runs out of an easily accessible supply of fresh meat and the epidemic peters out.

However, over time, as acquired immunity declines and new humans are born who lack immunity, the herd immunity declines. When the pathogen is reintroduced (via any one of a number mechanisms) another epidemic erupts. In between, there may be small outcrops of the disease, but it doesn't spread to become an epidemic. The disease is then said to be endemic.

In this, one needs to be aware of the definition of "epidemic". This is an incidence of a disease above that expected. If the expectation is zero, theoretically one case is an epidemic. If the disease is endemic, and there is a constant background of disease, it only becomes epidemic when the incidence rises above the background level.

This explains why epidemics, such as the Black Death, were cyclical. The plague never completely went away. It simply cycled through endemic to epidemic and back again.

The crucial point here, though, is to achieve herd immunity, anything up to 80 percent of the population must have acquired a level of immunity – effectively requiring as many as 50 million people in the UK to be exposed to the virus.

Assuming a fairly conservative death rate of one percent of those exposed to the virus, the government is conspiring, as a matter of public policy, to engineer the deaths of at least half-a-million of its citizens. Given that there are no systematic plans for treating large numbers of very ill people, the death rate will almost certainly be higher.

Therefore, the only thing substantially different from 2001 is that, so far, there are no mass graves being excavated. But it may even come to that.

Richard North 14/03/2020 link

Brexit: bring out your dead


With thirty-four days to go before we are scheduled to leave the European Union, it is difficult to know how we should be reacting to the prospect of an event which could presage a disaster – or not.

One possible response might be for the media to be putting together a comprehensive assessment of how the nation might be affected by a no-deal which looks more likely by the day.

Maybe they are keeping their powder dry – they'll certainly have plenty of time later and it would be difficult to keep up the momentum for over five weeks. There is only so much one can write, for so long.

For the moment, the media seem to have given up on Brexit as they focus on the domestic political agenda. This is a sort of comfort food for journalists who are otherwise totally out of their depth, leaving us assailed with tedious accounts of cabinet splits, backlashes and rows.

Where attention is being given to Brexit, the main topic seems to be whether an extension to the Article 50 negotiating period will be sought, this being the preferred method of stopping a no-deal Brexit. But missing from this aspect of the soap opera is the recognition that any extension must be approved unanimously by the EU-27.

Nevertheless, there are also the contrarians who reject the idea of taking a no-deal "off the table", one of these being John Penrose, minister of state for Northern Ireland.

He has been given space in The Sunday Telegraph to hold forth on the matter, arguing that to remove the no-deal option wouldn't just massively weaken the prime minister’s negotiating position. It could, says Penrose, torpedo Brexit completely, leaving us in a "Hotel California" Brexit, where we'd checked out but could never leave.

One is never quite sure with Tory politicians as to whether they are quite as stupid as they sound or are trying on some devious ploy, the nature of which is clear only to them.

But, in Mr Penrose's fertile imagination, he seems to believe that if we say we will never, ever leave without a deal, the EU would know, for certain, that they can stop Brexit in its tracks simply by refusing to agree a deal with us. Alternatively, he says, "if they're feeling subtle, by offering a bad deal they know parliament will turn down".

Either way, he concludes, they'd know we'd blink. Faced with those options, we couldn't take either of them. We would have no choice. We'd have to go cap in hand and beg the EU to delay the day we leave.

This text is taken more-or-less verbatim from Mr Penrose's authored piece in the ST, so it's an accurate reflection of what he writes. But, if he actually believes it, then he has a few problems.

Firstly, it is actually the case that the EU has agreed a deal with Mrs May, one which is now awaiting ratification by the Westminster parliament. Secondly, there is no further deal on offer – good or bad. And thirdly, if the deal is not ratified or if the EU-27 do not agree to a time extension, no-deal becomes the automatic default. Short of revoking the Article 50 notification – which Mrs May assures us she will not do – there is no other way of taking a no-deal off the table.

This, therefore, is an example of the fuzzy thinking that is going on inside the Westminster bubble which seems to have retreated so far from reality that it is no longer touching base with anything which approximates the real world. And, while we can still expect some fun and games in the House of Commons later in the week, there is nothing there which indicates that MPs fully understand what the word "default" means.

Nor, with the amount of hyperventilation over the prospect of parliament "taking control" of the legislative timetable, does there seem to be any recognition that the two measures that can influence the Brexit date – extension or revocation – both lie in the gift of the prime minister, subject to crown prerogative.

Thus, MPs can continue to behave like sulky teenagers, or wind themselves up into an almighty strop and start instructing Mrs May to take certain actions. But in the final analysis, the MPs will discover that their much-vaunted "sovereignty" does not reach outside their building. As the Queen's first minister in what is a constitutional monarchy, the prime minister can sit on her hands and do exactly nothing. And the outcome of that is that we drop out of the European Union on 29 March without a deal.

I doubt whether that was what Michel Barnier had in mind when he said earlier this week that he was more concerned than ever that the UK could crash out with a no-deal "by accident", but his instincts are probably right. A no-deal now looks to be the most likely outcome, and there is nobody on record offering any new fixes which would draw us back from the edge of the precipice.

And that, more than anything, is the most worrying of developments. If we were a nation on the brink of war, we would expect our politicians and diplomats to be rushing around in some modern-day version of shuttle democracy, doing everything humanly possible to avoid an outbreak of hostilities.

On a similar basis, one would expect all the relevant actors to be making every effort possible to ward off a no-deal Brexit, with the media following every development and reporting on every move.

With Mrs May headed to the Red Sea resort of Sharm El Sheikh, however, there is no sense of urgency and not the slightest intimation that any new initiatives are afoot. It has already been made very clear that the event is a summit with Arab leaders, so there is absolutely no prospect of a Brexit breakthrough.

That leaves the prime minister with a few more air miles, but with absolutely nothing to offer parliament that could possibly break the deadlock. And, by Thursday, there will only be 30 days left to Brexit.

Whether that will focus any more minds remains to be seen, but it is probably too late for the media to get its act together. Oddly enough, this week, even Booker has given up on Brexit, preferring instead to address the issue of "fake news", in the wake of the select committee report.

Although he is not allowed to make disparaging remarks about the print media, for the Telegraph, there is always an open house on attacks on the BBC, which allows Booker to take on board some of the more egregious lapses of the state broadcaster.

This very much puts the BBC in the frame as a major producer of fake news, but – as always – the Telegraph should be walking away with the prize, but for its own self-enforced immunity.

Its latest offering is a letter that has a small company owner claiming to ship products "to and from countries all over the world under World Trade Organisation protocols", whence he experiences "no problems".

As long as we are in the EU, however, trade with all but a couple of countries is conducted under the cover of agreements brokered by the EU and, since we are part of the EU's customs area, nothing is admitted to this country without coming under EU-mandated customs control.

Such a letter, therefore, should never have been published. All it does is represent part of the continued efforts by the Telegraph Media Group to distort the political agenda and mislead its readers.

That leaves the reading public subject to the same diet of misinformation that they've had to tolerate since well before the referendum, while bogged down in a quagmire of uncertainty which leaves us still guessing as to the outcome of Brexit as the clock ticks down to zero.

Still, perhaps the latest news from the Sunday Times will prove to be the game changer. It is telling us that Whitehall fears there will be "piles of bodies at ports" after no-deal Brexit, as any disruption to the free flow of goods, aircraft and ships would have a knock-on effect on the ability to repatriate the bodies of non-UK nationals who die in Britain.

If the worst comes to the worst, one can imagine us hearing a call not heard in England since the black death, as carts tour the streets with the drivers calling, "Bring out your dead". When the slaughter of the first-born follows, we might even consider a referendum on whether to go for the plague of locusts.

Richard North 24/02/2019 link

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