The Problem

Many doctors’ surgeries and health centres have closed due to the current Covid-19 pandemic. This has meant that many of our members are unable to get their live-saving injections of B12. This is leading to members’ worrying about their future health. Many patients are already having to endure a three-monthly treatment regimen which means that they are already suffering from the returning symptoms of B12 deficiency long before their injection is due.

What you can do

If you are worried that your symptoms are worsening you may want to consider using other sources of delivering B12. However, be aware that with the exception of option #4, where a small study has taken place in an unrepresentative patient group, there has been no robust investigation into how effective these other delivery methods are (except on blood values). You will have to satisfy yourself that the source is a reliable one. Certainly, injections are the best way to ensure you get B12 if you have Pernicious Anaemia – after all that’s why they were developed.

If you are experiencing any neurological and/or neuropsychiatric symptoms (like pins and needles, burning legs/feet, numbness) you must mention this to your GP via a telephone conversation, as this could be the first signs of nerve damage due to lack of B12. Explain to your doctor that vitamin B12 plays a crucial role in the healthy balance of the immune system, and abnormalities in the immune system in pernicious anemia are restored by vitamin B12 replacement therapy. Inadequate levels of folid acid and B12 can alter immune response and adequate levels can prevent inflammation, immune dysfunction and disease progression. Vitamin B12 injections are essential medication, not just a supplement, especially at a time like this.

We do not recommend any particular one of the following options, you will have to decide for yourself which is best suited to you. And of course, there is always the option of not doing anything and waiting until the pandemic has run its course and your surgery or health centre re-opens.

Here are the options you might want to consider and discuss with your GP via a telephone conversation:

Option #1 – Use an alternative health professional for injections

Contact your health centre or surgery and ask your GP to write you a prescription for your B12. Pick up the prescription.
You may need to visit a ‘Needle Exchange Centre’ to pick up some single-use syringes, along with pre-injection wipes and a lockable sharps bin.
Now the tricky bit. You will need to find a medical professional who can administer the injection. This may be a neighbour, a friend or a member of your family.

Option #2 – Self-Injecting

If you cannot identify anyone who is qualified to administer the injection you might want to ask your GP if you would be able to self-inject. More and more GP’s are sanctioning this though some will respond to any request in horror. If you are considering self-injecting: UK legislation means that a valid prescription is needed for the supply of injectable B12 for medical purposes. We are aware that significant numbers of patients with PA are not getting their injections at the moment and have taken the decision to source injectable B12 for self treatment, either using humanitarian legislation that permits the import of essential medical drugs for personal use where it is not available in the UK,or sourcing from health and beauty suppliers who are not covered by prescription only rules. If you do find yourself unable to obtain injections through you GP at this time and decide to go down the route of sourcing and injecting B12 yourself then please ensure you follow these tips to minimise the risks:
• Ensure that there is someone there with you when you inject yourself.
• Talk to any fellow members who already self-administer and ask their advice.
• Watch instructional videos on YouTube – you don’t have to inject into the muscle, sub-cutaneous injections which go under the skin are effective.
• Never use the needle more than once and dispose of it in the sharps box.

Option #3 – Sub-Lingual Lozenges

Consider using Sub-Lingual Lozenges (with hydroxocobalamin or methylcobalamin) which are available from online health shops and in some high street health shops. They are available in different strengths and are placed under the tongue where the vitamin enters the bloodstream via a membrane that is found under the tongue or in the cheeks. Many of our members use these as a first choice to supplement between injections, or even instead of) as the absorption takes place in the mouth rather than taking a chance of passive diffusion in the stomach.

Option #4 – Oral Supplements

Consider sourcing strong oral tablets of B12 – 1mg or 2mg. These are readily available on the internet though you will have to satisfy yourself that the source is a reliable one. Oral tablets are not suitable for patients with Autoimmune Pernicious Anaemia because patients with PA cannot absorb B12 in their stomach. But, if the tablets are strong enough, perhaps 1% will be absorbed by Passive Diffusion though the science behind this is very weak. It is, however, an option you might want to consider.

Option #5 – Sub-Lingual Sprays

There are sub-lingual Sprays available which, again, some of our members use as their supplement of choice. They are readily available from Health Shops and online. Again the absorption into the bloodstream is via membranes under the tongue or cheeks.

Option #6 – Sub-Lingual Drops

Not as popular as the spray or lozenges, these work the same way using a dropper to deliver the liquid under the tongue.

Option #7 – Transdermal Patches

These are available from online stores and are a popular way of delivering B12. They are available online.

Option #8 – Private Doctors

You may consider contacting a private doctor or health provider who may still be seeing patients and who will happily provide an injection in return for a fee.

Managing Pernicious Anaemia in the time of Corononavirus: What can GP surgeries do

Dr. Rietsema has written a short article for doctors where she outlines the problems faced by our members and suggests alternative treatments:
Managing Pernicious Anaemia in the time of Corononavirus – What can GP surgeries do when there simply is not the time or staff to deal with routine injections?

The Future

Nobody really knows how long the Coronavirus epidemic will last. Some believe it will peak in the UK in early April, while other commentators believe it will be June before it peaks. Hopefully it won’t be too long before normal treatment of Pernicious Anaemia returns. In the meantime, please follow the UK Government’s advice and wash your hands regularly, don’t touch your face, practise social distancing and consider self-isolating. If you develop the symptoms then you should quarantine yourself for 14 days and contact your GP by telephone or telephone 111.
Members who are outside the UK should consult their respective government’s advice.