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Coronavirus: Five skin conditions associated with Covid-19 to look out for – Mirror Online

April 30th, 2020

Five skin conditions associated with coronavirus have been identified by dermatologists, according to a new study.

The research, carried out on 375 patients in Spain, aimed to build a picture of how the disease might manifest in skin symptoms.

Through the Spanish Academy of Dermatology, all Spanish dermatologists were asked to help identify patients who had an unexplained skin “eruption” in the last two weeks and who had suspected or confirmed Covid-19.

A standardised questionnaire was used and photos taken of skin conditions to detect patterns of the virus’s potential effect on the skin.

Authors of the study, published in the British Journal of Dermatology, said that in some cases it was hard to tell if skin conditions were directly caused by coronavirus or indicated complications.

The public is being urged not to try to self-diagnose Covid-19 based on skin symptoms (stock photo)
(Image: Getty Images/iStockphoto)

As a result, the public is being urged not to try to self-diagnose Covid-19 based on skin symptoms, because rashes and lesions are common and hard to differentiate without medical expertise.

Chilblain-like symptoms

The study found that in 19% of its cases chilblain-like symptoms were identified.

Described as “acral areas of erythema-edema with some vesicles or pustules”, these lesions affect the hands and feet and may resemble the small, itchy swellings of chilblains.

They are small red or purple spots caused by bleeding under the skin and usually asymmetrical in appearance, the study said.

The study tried to detect patterns of the virus’s potential effect on the skin (stock photo)
(Image: Getty Images/iStockphoto)
In 19% of its cases chilblain-like symptoms were identified (stock photo)
(Image: Getty Images/iStockphoto)

The symptoms were associated with younger patients, lasted for an average of 12.7 days, appeared later in the course of Covid-19 and were associated with less severe cases of the disease.

Vesicular eruptions

In 9% of cases, dermatologists identified “vesicular eruptions”, described as outbreaks of small blisters, commonly itchy, that appeared on the trunk of the body.

These could also affect people’s limbs, may be filled with blood, and could become larger or more spread out.

They were associated with middle-aged patients, lasted on average 10.4 days, appeared more commonly before other symptoms and were associated with intermediate severity of the disease.

Urticarial lesions

A third condition, identified in 19% of cases, was named as “urticarial lesions”, which consist of pink or white raised areas of skin resembling a nettle rash.

Known as wheals, these are usually itchy and can be spread across the body, including in a few cases on the palms of hands.

Catalan police speak to motorcyclists at a check point in Barcelona last week
(Image: Getty Images)

Maculopapules

Among 47% of cases “other maculopapules” were identified – small, flat and raised red bumps.

In some cases these were distributed round hair follicles and had varying degrees of scaling.

The study said the appearance was likened to pityriasis rosea, a common skin condition.

Blood spots under the skin might also be present, either as spots or dots or on larger areas.

Urticarial lesions were found to last an average of 6.8 days, while a maculopapular condition lasted on average 8.6 days.

They usually appeared at the same time as other Covid-19 symptoms, were associated with more severe Covid-19 cases, and itching was very common.

Police officers wearing face masks as a preventive measure in Barcelona
(Image: Paco Freire/SOPA Images/Shutterstock)

Researchers noted that maculopapules and urticarial lesions are common and can have many causes, meaning they may not be a helpful aide for diagnosing Covid-19.

Livedo or necrosis

A fifth category of conditions, Livedo or necrosis, was identified by dermatologists in 6% of cases.

Livedo occurs where circulation in the blood vessels of the skin is impaired, causing it to take on a blotchy red or blue appearance with a net-like pattern.

Necrosis describes the premature death of skin tissue.

The study said patients showed different degrees of lesions pointing to “occlusive vascular disease”, where a narrowing or blocking of arteries occurs, limiting blood flow to certain areas of the body.

These conditions were associated with older patients with a severe case of Covid-19, although manifestations of the disease in this group were variable.

Livedoid and necrotic lesions are relatively uncommon but the study authors said it was difficult to know if they were directly caused by Covid-19, or simply indicated complications.

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“COVID toes” and other skin symptoms may be a sign of coronavirus – CBS News

April 30th, 2020

There is still much to learn about the novel coronavirus, including a wide range of symptoms that appears to be expanding. Common symptoms of the respiratory illness include fever, cough, shortness of breath and chills, but some doctors have reported less obvious symptoms in some patients — including what some are calling “COVID toes” and other skin ailments.

Esther Freeman, director of Global Health & Dermatology at Massachusetts General Hospital and an assistant professor a Harvard Medical School, said “COVID toe” cases look similar to pernio or chilblains, a condition of inflamed blood vessels caused by cold temperatures.

“We’re seeing this inflammatory response that we would normally see when someone was exposed to the cold temperature… like someone who has been playing outside with wet socks,” Freeman told CBS News. “However, in this setting, we’re seeing it in warm climates and we’re seeing it in patients who have been indoors and sheltering in place.”

Freeman said it’s not unusual for a virus to cause a rash, so most dermatologists aren’t surprised that COVID-19 could cause skin symptoms. “What is surprising to me are these ‘COVID toes,’ these pernio-like lesions…because we haven’t seen as many reports of these in other viruses.”

Freeman is a practicing dermatologist at Massachusetts General Hospital who has been seeing patients via tele-health video appointments. “I have seen more toes in the past two weeks in my clinic than I have in my entire previous career combined,” said Freeman, who is a member of American Academy of Dermatology (AAD) COVID-19 task force. 

Aside from seeing skin symptoms in her own patients, Freeman has also received examples of these symptoms from health care providers all over the world. The AAD COVID-19 task force set up an international registry for physicians to send in examples of dermatological manifestations of COVID-19, to help further the study of these symptoms. Physicians from 21 different countries have sent in information to the registry so far.

Freeman said “COVID toes” have been seen in both children and adults. They are sometimes present along with more typical coronavirus symptoms, and sometimes they are the only symptom the patient is experiencing. “Actually, about half of the registry is experiencing something other than toes,” Freeman said. 

Some physicians have also reported seeing skin conditions that look like morbilliform (measles-like) rashes, hives or chickenpox. 

In fact, one of the first case series of dermatologic manifestations included 18 Italian patients with several skin abnormalities including redness, hives and rashes, often on their torsos, Freeman and her colleagues write in the Journal of American Academy of Dermatology.

Freeman says her own patients tend to come to her with two main concerns. “The first thing they want to know is ‘My toes are purple, am I going to get really sick?’ I can be reassuring that most of the patients in our registry, most of the data that we’re looking at, are doing really very well,” Freeman said. “The second thing my patients want to know is, ‘Am I potentially infectious? Could I be infecting my family members?'”

Freeman said it is important to be cautious because some “COVID toe” patients might still be infectious and should talk to their doctor about getting a coronavirus test.

“The overall message I want to tell the public is not to panic,” Freeman said. “Most of our patients who have these ‘COVID toes’ are doing extremely well.”

“If you need to go to the ER because you’re otherwise sick or you have other symptoms you need to be evaluated for, that’s fine. But if the only symptom you have is purple toes, you don’t need to go rushing into the ER,” Freeman said, adding that if a patient does experience toe or skin abnormalities, they should talk to their physician. 

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A group of researchers from Belgium and Oregon published a study documenting a case of so-called “COVID toes” in a 23-year-old man. JAAD

A team of dermatologists from Brussels, Belgium and and Portland, Oregon have also studied toe and skin infections in relation to COVID-19. In a case report published in JAAD, they say it’s important for dermatologists to recognize the signs.

The researchers write about a 23-year-old man who had “acute-onset” purplish and painful plaques on his toes and the outer side of his feet for three days. For several days before that, he’d also had a low-grade fever and dry cough.

After a complete skin examination, the patient tested positive for COVID-19. The researchers say he was diagnosed with “COVID-19 infection–induced chilblains,” the medical term for the skin sores. Similar cases have been observed by French and Belgian dermatologists, but had not been previously reported due to lack of testing, the researchers said.

“Young patients presenting with chilblains have lacked criteria sufficient to allow for a COVID-19 PCR test,” according to the study. “Because of the recent outbreak of chilblains, concurrent with the increase of COVID-19 cases, COVID-19 has been widely suspected as the etiology,” or cause, they write.

This study looked COVID-19 chilblains cases in children and young adults, whose feet have been more affected than their hands.

“Chilblains may be the inaugural symptom of COVID-19, and a fever and dry cough may be minimal or even absent,” according to the study.

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Face ID doesn’t work when you’re wearing a mask—Apple’s about to fix that – Ars Technica

April 30th, 2020

Fortnite World Cup 2020 has been canceled – The Verge

April 30th, 2020

Fortnite World Cup 2020 has been canceled – The Verge

April 30th, 2020

1 confirmed dead, 5 missing in Canadian military helicopter crash off Greece – CTV News

April 30th, 2020

TORONTO — Canadian Armed Forces have confirmed the identities of the six crew members who were on board the military helicopter that crashed during a NATO training exercise off the coast of Greece.

During his daily briefing in Ottawa Thursday, Prime Minister Justin Trudeau said that one body has been recovered and five others are missing.

“All of them are heroes. Each of them will leave a void that cannot be filled,” he said.

The prime minister was joined by Chief of the Defence Staff Gen. Jonathan Vance who said they had confirmed the death of one sailor, Sub-Lt. Abbigail Cowbrough of Nova Scotia.

“This is a time of agony for all families, friends and fellow crew members. There is nothing worse than sending your shipmates over the horizon and losing contact,” he said.

On Thursday afternoon, the Canadian Armed Forces also confirmed the identities of the five missing crew members:

  • Capt. Brenden Ian MacDonald from New Glasgow, N.S.
  • Capt. Kevin Hagen from Nanaimo, B.C.
  • Capt. Maxime Miron-Morin, from Trois-Rivieres, Que.
  • Sub-Lt. Matthew Pyke from Truro, N.S.
  • Master Cpl. Matthew Cousins from Guelph, Ont.

Military members on HMCS Fredericton, along with NATO allies, are continuing to search for the other five members of the helicopter’s crew.

Trudeau said the helicopter was flying from Halifax-based naval frigate HMCS Fredericton as part of NATO’s Operation Reassurance. The CH-148 Cyclone lost contact during an allied exercise over the Ionian Sea on Wednesday.

“This is another very hard day for Halifax, for Nova Scotia, and for our Armed Forces families. I am so very sorry for your loss,” he said.

In a brief statement released Thursday, NATO said that aircraft from Canada, Italy, and Turkey were carrying out search operations for the helicopter with additional support from Greece and the U.S.

Vance said search efforts have been complicated by a large debris field and the fact the helicopter crashed in 3,000-metre deep water.

Defence Minister Harjit Sajjan said the cause of the incident is unknown at this time. He said the voice and data recorders that broke away from the helicopter during the crash had been recovered and would be transported back to Canada for the investigation.

Vance said approximately 240 CAF members who left Halifax in January, to take part in NATO’s Operation Reassurance, had just completed their 100th day of the mission. They are expected to return to Canada in July.

According to NATO, HMCS Fredericton recently sailed from Souda, Greece to continue with its mission of “maritime situational awareness” in the Mediterranean.

The ship had been a unit of Standing NATO Maritime Group Two (SNMG2) and had performed several exercises with units of the Turkish Navy and the Hellenic Navy and Air Force this past week, NATO said in a statement Thursday.

Prior to that, the ship visited Italy in March, before it was to travel to Greece and the Black Sea as one of eight warships in SNMG2.

Trudeau said NATO Secretary General Stoltenberg offered his condolences when they spoke earlier on Thursday.

Greek Prime Minister, Kyriakos Mitsotakis, also shared his condolences.

“I express my grief over the crash of the Canadian helicopter in the Ionian Sea last night,” he told parliament on Thursday.

Mitsotakis added that he intended to call Trudeau to extend his sympathies.

The helicopter carrying six CAF members had just completed a training exercise with Italian and Turkish warships and was flying back to the ship when it lost contact at approximately 6:52 p.m. local time on Wednesday, Vance said. He didn’t say whether there had been a mayday call, but the data and voice recorders were lit up automatically by flares when they broke off the helicopter.

The chief of the defence staff said a military flight investigation team would be deployed to the area where the crash occurred on Thursday or Friday.

As a result of the crash, Vance said the Cyclone helicopter fleet was on an “operational pause” to allow flight safety teams to investigate and rule out any potential fleet-wide problems. The Royal Canadian Air Force owns 17 other Cyclone helicopters.

When asked if he had any concerns about the fleet, Vance defended the helicopters’ performance.

“It’s a powerful helicopter with fantastic sensing capability,” he said. “I don’t have any lack of confidence in this fleet.”

The Canadian military only began using Cyclone helicopters for missions in late 2018 after more than a decade of expensive delays with the manufacturer Sikorsky. In 2008, the military was supposed to receive 28 Cyclone helicopters, to replace its aging CH-124 Sea Kings, but they only have 18 of the helicopters to date.

First victim identified

Earlier on Thursday, the family of the first victim identified in the crash, Sub-Lt. Abbigail Cowbrough, shared news of her death on social media.

In a Facebook post, Shane Cowbrough confirmed that his daughter Abbigail was among the victims.

“I am broken and gutted,” he wrote. “There are no words. You made me forever proud. I will love you always, and miss you in every moment. You are the bright light in my life taken far too soon.”

Tanya Cowbrough, Abbigail’s mother, also shared the devastating news on her Facebook page.

“My beautiful daughter has been in a military accident and passed away. She will no longer pipe her songs to all those that love her,” she wrote. “The very beating no fluttering of my heart has stopped. Nothing can replace her.”

The Regal Heights Baptist Church in Dartmouth, N.S. posted about Abbigail Cowbrough’s death in a Facebook post early Thursday morning.

“Our church family has lost a wonderful woman,” the post read. “Our prayers are with her family, and all those who have lost a loved one in this tragic accident.”

The church also shared two photos of Abbigail Cowbrough. In one, she can be seen playing the bagpipes during a Remembrance Day ceremony in Dartmouth last year. The other photo shows Abbigail Cowbrough aboard HMCS Fredericton, which she sent to the church to show them where she was spending quarantine during the pandemic.

The young woman was known as a talented bagpiper who played for Halifax Regional Fire Service’s Union Fire Club Pipes and Drums band. In a Facebook post Thursday, the band said they were “profoundly saddened” by her death.

“She was an amazing person and loved by all who met her. Abbi thank you for joining our little band and making it better. See you on the counter march!” 

With files from CTV News’ Michel Boyer, CTVNews.ca’s Ben Cousins, and The Canadian Press

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Louisiana girl with coronavirus developed rare inflammatory condition that temporarily stopped heart: report – Fox News

April 30th, 2020

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A 12-year-old girl in Louisiana infected with the novel coronavirus reportedly developed a rare inflammatory syndrome that temporarily stopped her heart. The condition may be the same one that doctors in the United Kingdom and elsewhere have warned is possibly linked to COVID-19 infections in some children.

Three weeks ago, Juliette Daly was in a battle for her life after she was airlifted to Ochsner Medical Center in New Orleans. She tested positive for the novel virus despite not showing any typical symptoms of it, according to local news station WBRZ. She reportedly went into cardiac arrest as doctors worked to insert a breathing tube.

CORONAVIRUS: WHAT YOU NEED TO KNOW

“After they put the breathing tube down her throat, her heart stopped and they had to do extreme measures. They had to do two minutes of CPR. At that point, my whole world just crumbled,” Jennifer Daly, Juliette’s mother, told the outlet. She said her daughter had been “perfectly” healthy prior to her hospitalization and is a generally active child.

“I died for two minutes,” Juliette said. “I felt really bad; my stomach would not stop hurting. I didn’t want to move; I didn’t want to live, I wanted for it all to stop.”

The preteen was then diagnosed with a rare inflammatory condition that can lead to high fevers and swollen arteries, similar to Kawasaki disease, or a condition that causes swelling in medium-sized arteries throughout the body. Kawasaki disease, which primarily affects children, often leads to inflammation in the coronary arteries, according to the Mayo Clinic.

“COVID-19 can infect the heart and it can cause the cells in the heart to be unhappy and actually start to die,” pediatric cardiologist Dr. Jake Kleinmahon told WBRZ.

The 12-year-old is reportedly on the mend.

The 12-year-old is reportedly on the mend. (iStock)

Thankfully, Juliette is on the mend. Her mother said she is grateful for the quick treatment her daughter received.

The news comes after British health authorities in a warning to health care professionals over the weekend said that some severely ill pediatric patients in the country — including some who have tested positive for the coronavirus — have presented an “unusual clinical picture” that includes inflammatory symptoms possibly linked to COVID-19.

The U.K. Pediatric Intensive Care Society (PICS), citing an email alert from the National Health Service (NHS) England, said in a news release that health officials have reported “a small rise in the number of cases of critically ill children presenting with an unusual clinical picture,” or, more specifically, a “multi-system inflammatory state” that may be connected to the novel virus.

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“The cases have in common overlapping features of toxic shock syndrome and atypical Kawasaki disease with blood parameters consistent with severe COVID-19 in children. Abdominal pain and gastrointestinal symptoms have been a common feature as has cardiac inflammation,” the NHS notice reads, per PICS.

A similar condition also affected at least three children in New York who have tested positive for the novel virus.

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‘Call of Duty: Modern Warfare 2’ remaster hits Xbox One and PC – Engadget

April 30th, 2020

We found and tested 47 old drugs that might treat the coronavirus: Results show promising leads and a whole new way to fight COVID-19 – The Conversation US

April 30th, 2020

The more researchers know about how the coronavirus attaches, invades and hijacks human cells, the more effective the search for drugs to fight it. That was the idea my colleagues and I hoped to be true when we began building a map of the coronavirus two months ago. The map shows all of the coronavirus proteins and all of the proteins found in the human body that those viral proteins could interact with.

In theory, any intersection on the map between viral and human proteins is a place where drugs could fight the coronavirus. But instead of trying to develop new drugs to work on these points of interaction, we turned to the more than 2,000 unique drugs already approved by the FDA for human use. We believed that somewhere on this long list would be a few drugs or compounds that interact with the very same human proteins as the coronavirus.

We were right.

Our multidisciplinary team of researchers at the University of California, San Francisco, called the QCRG, identified 69 existing drugs and compounds with potential to treat COVID-19. A month ago, we began shipping boxes of these drugs off to Institut Pasteur in Paris and Mount Sinai in New York to see if they do in fact fight the coronavirus.

In the last four weeks, we have tested 47 of these drugs and compounds in the lab against live coronavirus. I’m happy to report we’ve identified some strong treatment leads and identified two separate mechanisms for how these drugs affect SARS-CoV-2 infection. Our findings were published on April 30 in the journal Nature.

Every place that a coronavirus protein interacts with a human protein is a potential druggable site. QBI Coronavirus Research Group, CC BY-ND

The testing process

The map we developed and the FDA drug catalog we screened it against showed that there were potential interactions between the virus, human cells and existing drugs or compounds. But we didn’t know whether the drugs we identified would make a person more resistant to the virus, more susceptible or do anything at all.

To find those answers we needed three things: the drugs, live virus and cells in which to test them. It would be optimal to test the drugs in infected human cells. However, scientists don’t yet know which human cells work best for studying the coronavirus in the laboratory. Instead we used African green monkey cells, which are frequently used in place of human cells to test antiviral drugs. They can be readily infected with the coronavirus and respond to drugs very closely to the way human cells do.

After infecting these monkey cells with live virus, our partners in Paris and New York added the drugs we identified to half and kept the other half as controls. They then measured the amount of virus in the samples and the number of cells that were alive. If the samples with drugs had a lower virus count and more cells alive compared to the control, that would suggest the drugs disrupt viral replication. The teams were also looking to see how toxic the drugs were to the cells.

With dozens of drugs each needing full testing, to get results in four weeks required round-the-clock effort. Quantitative Biosciences Institute, CC BY-ND

After sorting through the results of hundreds of experiments using 47 of the predicted drugs, it seems our interaction predictions were correct. Some of the drugs do in fact work to fight the coronavirus, while others make cells more susceptible to infection.

It is incredibly important to remember that these are preliminary findings and have not been tested in people. No one should go out and buy these drugs.

But the results are interesting for two reasons. Not only did we find individual drugs that look promising to fight the coronavirus or may make people more susceptible to it; we know, at a cellular level, why this is happening.

We identified two groups of drugs that affect the virus and they do it two different ways, one of which has never been described.

Disrupting translation

At a basic level, viruses spread by entering a cell, hijacking some the cell’s machinery and using it to make more copies of the virus. These new viruses then go on to infect other cells. One step of this process involves the cell making new viral proteins out of viral RNA. This is called translation.

When going through the map, we noticed that several viral proteins interacted with human proteins involved in translation and a number of drugs interacted with these proteins. After testing them, we found two compounds that disrupt the translation of the virus.

The two compounds are called ternatin-4 and zotatifin. Both of these are currently used to treat multiple myeloma and seem to fight COVID-19 by binding to and inhibiting proteins in the cell that are needed for translation.

Plitidepsin is a similar molecule to ternatin-4 and is currently undergoing a clinical trial to treat COVID-19. The second drug, zotatifin, hits a different protein involved in translation. We are working with the CEO of the company that produces it to get it into clinical trials as soon as possible.

The coronavirus attacks human cells using dozens of devious tricks. narvikk/iStock Getty Images Plus via Getty Images

Sigma receptors

The second group of drugs we identified work in an entirely different way.

Cell receptors are found both inside of and on the surface of all cells. They act like specialized switches. When a specific molecule binds to a specific receptor, this tells a cell to do a specific task. Viruses often use receptors to infect cells.

Our original map identified two promising MV cell receptors for drug treatments, SigmaR1 and SigmaR2. Testing confirmed our suspicions.

We identified seven drugs or molecules that interact with these receptors. Two antipsychotics, haloperidol and melperone, which are used to treat schizophrenia, showed antiviral activity against SARS-CoV-2. Two potent antihistamines, clemastine and cloperastine, also displayed antiviral activity, as did the compound PB28 and the female hormone progesterone.

Remember, all these interactions have so far only been observed in monkey cells in petri dishes.

At this time we do not know exactly how the viral proteins manipulate the SigmaR1 and SigmaR2 receptors. We think the virus uses these receptors to help make copies of itself, so decreasing their activity likely inhibits replication and reduces infection.

Interestingly, a seventh compound – an ingredient commonly found in cough suppressants, called dextromethorphan – does the opposite: Its presence helps the virus. When our partners tested infected cells with this compound, the virus was able to replicate more easily, and more cells died.

Laboratory testing is excellent at generating leads but clinical trials must be done to know if these findings translate to the real world. Quantitative Biosciences Institute, CC BY-ND

This is potentially a very important finding, but, and I cannot stress this enough, more tests are needed to determine if cough syrup with this ingredient should be avoided by someone who has COVID-19.

All these findings, while exciting, need to undergo clinical trials before the FDA or anyone else should conclude whether to take or stop taking any of these drugs in response to COVID-19. Neither people nor policymakers nor media outlets should panic and jump to conclusions.

Another interesting thing to note is that hydroxychloroquine – the controversial drug that has shown mixed results in treating COVID-19 – also binds to the SigmaR1 and SigmaR2 receptors. But based on our experiments in both labs, we do not think hydroxychloroquine binds to them efficiently.

Researchers have long known that hydroxychloroquine easily binds to receptors in the heart and can cause damage. Because of these differences in binding tendencies, we don’t think hydroxychloroquine is a reliable treatment. Ongoing clinical trials should soon clarify these unknowns.

Treatment sooner rather than later

Our idea was that by better understanding how the coronavirus and human bodies interact, we could find treatments among the thousands of drugs and compounds that already exist.

Our idea worked. We not only found multiple drugs that might fight SARS-CoV-2, we learned how and why.

But that is not the only thing to be excited about. These same proteins that SARS-CoV-2 uses to infect and replicate in human cells and that are targeted by these drugs are also hijacked by related coronaviruses SARS-1 and MERS. So if any of these drugs do work, they will likely be effective against COVID-22, COVID-24 or any future iterations of COVID that may emerge.

Are these promising leads going to have any effect?

The next step is to test these drugs in human trials. We have already started this process and through these trials researchers will examine important factors such as dosage, toxicity and potential beneficial or harmful interactions within the context of COVID-19.

[The Conversation’s most important coronavirus headlines, weekly in a new science newsletter.]

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Party royale could fulfill Fortnite’s promise as a true social space – The Verge

April 30th, 2020