Today, given that I’m currently still afflicted with a viral infestation that’s making it hard to properly breathe and hard to think or focus, I’ll be talking about illness in RPGs, and how handling them might be done a bit differently from the usual model of “Oh, here, have some minor stat penalties.”
Generally, disease isn’t really touched upon in RPGs, and for good reason. It’s hard to be a heroic do-gooder if you’re laid out by the flu, and in many games there are ways to deal with disease that essentially make them a short-lived nuisance. Clerics with Cure Disease and nanotechnology with medichines that cleanse your body of foreign agents make common illness unimpressive.
Still, there are games without these effects, and there are diseases that can get around them by any number of methods. Even in games with these benefits, there are cases where they won’t matter, and in these cases we might want to take a better look at how we treat these nasty little things.
Let’s look at, for example, Pathfinder. Remove Disease is a third-level spell, which means you have to be a fifth level cleric or a sixth level oracle (or equivalent) to cast it. That means access to that kind of magic isn’t easy, since not many people have class levels in PC classes like that, and fewer of those have enough class levels to gain access to that kind of magic. Being able to outright purge a disease from a person is useful, and a good reason that most well-off households will either be friends with such a person or have one hired directly on as a member of the household staff.
What this doesn’t do is provide any kind of protection for those who can’t afford those fees; for the common laborer, this situation is much more like that of the average poor person in the American medical system, where to heal a sickly loved one of a deadly illness they may have to go into lifelong debt. I imagine there’s a fair chunk of the Asmodean church’s labor pool that comes from this exact source. Plagues are still a thing that can happen in the game world, because there will never be enough magic to go around to wipe them out. Even with the cures that alchemists can produce and wands for backup, there will always be diseases on the loose.
Which makes it something of a shame that diseases get treated the way they do; while not heroic, for those groups looking to add a dose of realism to their game, diseases can offer a lot of impact for a little effort. Diseases tend to come with exhaustion, malaise, and body pain that make regular life a struggle, much less the life of an adventurer, and you can easily represent these in a mechanical form with a blanket penalty to roll for the duration of the disease. Diseases that get worse over time (with consecutive failed saves) may start stacking the penalty, until the mechanical effect mirrors that of a person who really doesn’t have the energy to get up and do anything unless forced to it until the disease runs its course. This can be mitigated to an extent, of course – alchemical stopgaps that relieve the symptoms and let the victim keep going, much like Tylenol can help someone with the flu or a bad cold to keep functioning, or spells like lesser restoration that could, perhaps, reset the severity of the symptoms to an earlier stage.
This isn’t factoring in the strange plagues that become possible in a fantasy world, of course – things like mummy rot and lycanthropy (or other forms of shapeshifting ‘disease’) might more rightly be called a curse. It remains up to the GM if they’re diseases or curses, however, or if there might be forms of both in the world. Supernatural forms of regular diseases may exist, as well – the kind of cold that a dragon in human form has might just be a nuisance to it, but if it can be passed along to a human it might be impossible to get over it and have dire side effects. Black Dragon Flu might well have you sneezing clots of corrosive snot that can leave acid scars all over; Troll Fever might seem like a disguised blessing, since you heal unnaturally quickly under the effects, but you can’t even stand mild acids like vinegar and you have an atavistic fear of fire while sick – and then you discover how hard it is to set a bone that heals that rapidly and come to understand why trolls tend to look kind of deformed. Supernatural diseases may be upgraded version of regular ones – a form of leprosy that only infects arcane spellcasters, getting stronger if they work magic even as it deforms their fingers and makes those spells harder to cast correctly, or even just a case of the flu that shrugs off Remove Disease.
I am, I admit, unlikely to incorporate this kind of thing into many of my future games, unless I do something like reworking Alpha Omega or if I run one of the Pathfinder APs that involve a plague or a significant patch of disease. Still, it’s worth considering at least minor impacts of a disease in the context of game mechanics, worlds, and flavor. Next time I’ll likely pick this thread up again, to show how you could possibly handle diseases in other game systems; the Cypher System and Eclipse Phase both spring to mind as games where disease might play a significant role and thus be worthy of looking over.
Until then, keep playing and keep your head above the water.