Magical Malaise

Part 1 of the "Medicine, Malaise, Herbs & Healing" Series

Yup you saw that right folks this post was going to be so long that I instead had to break it out into a series. Something which those who have been reading this blog for awhile know must have been getting to beyond ridiculous lengths as I have yet to break apart even the longest of my rants. Go get your drinks and snacks cause this is going to be a long and wild ride. Now I think about alot of things in TTRPGs probably more in depth then I am meant to but one thing I keep coming back to is diseases and injuries and how magic would effect them. This whole world is filled with magic, healing and mysticism that there couldn't possibly be a way that doesn't bleed over into sickness as well. In fact there have been some really great 3rd party supplements talking about magical diseases (you'll find a link in my reference blurb below). BUT even normal diseases would start to get corrupted by all this magic flying around, there is no way they couldn't. Which leads us neatly into the first part of this series - how magic would mutate normal mundane diseases and what an outbreak of that would look like. Now to be clear I will be giving viral and parasite examples, heavy on the viral. Honestly bacterial outbreaks are a whole other crazy thing that maybe we will tackle at a later date, let me know down in the comments section if you are interested in that.

Before we dive into it head first I just wanted to give a shout out to some of the many things that have all jumbled about in my head to bring about these ponderings and rules. They are some real MVPs of PC strife and I'd like to give each one a little spotlight. DnDSpeak, Malady Codex, Viruses Plagues & History, Murderous Contagion, Nerdarchy, RPG MD, Briar's Book (Circle of Magic #4), Parasitology Book 1 and Extra History 1918 Flu Pandemic as always probably many more that have fallen through my brain pan.

With that house keeping out of the way Imma lay down some sweet sweet structure for how I went about this. To create a starting point I took some of the most well known diseases in history and boiled them down to their most basic parts, then used that to create a mechanic crunchy bit on how they work normally in the world (in this case D&D 5e). Each of those diseases have a base cure DC based off of their severity when they first infect a person and then the DC increases as the disease would naturally progress by +2. These are the building blocks we will be using in a bit to then do some funny business to.  I want to be clear that I'm not trying to belittle, mock or comicalize any of these diseases. These are all actual things in our world, and effect real people even today. My point is to give examples that you would be familiar with in order to see how we can translate over diseases and therefore their lessons of epidemic outbreak. I would say talk about that with your players once an epidemic has been realized in the game, it doesn't have to be a talk that gives anything away story wise. But a quick check in as this holds some very real triggers for people is highly suggested. Find a few examples of mundane diseases created in this way below for review, please remember these haven't had a ton of playtest time as this is something that rarely pops up in my games. But you never know I might just make my PCs run through a disease investigation team the next time we have to spin up a new campaign.

Smallpox (Cure DC 12)

When playing an NPC that is infected there are a few things to remember. They show no outward signs of infection for a very long time, putting them in contact with alot of people. Its easy to ignore the mild fever and some itchiness but subtly using these when describing the NPC or their interactions with those around them is a great way to lead to paranoia in the party later. Describing the symptoms like this early without a heavy hand to give it away will make the party have an ah ha moment later on once the epidemic is in full swing. As we move into some of the harsher symptoms and outcomes of this disease like extreme fever and brain swelling remember to begin to act delirious, irrational, and in some causes hysterical.

The disease lasts on average 66 days divided into 3 stages. Stage 1 (1d20 - 2 days) - disease not visually evident, highly contagious (75% if in contact with infected), mild fever and itching. Stage 2 (1d3 x 10 days ) - disease begins to appear via red rash and poxes on the skin, still highly contagious (80% if in contact with infected +5% if in contact with the pox of an infected); high fever, coughing,  itchiness. Stage 3 (1d10 +3 days) - Highly contagious (90% if in contact with infected, +5% if in contact with pox of infected); extreme fever with 25% chance of causing brain swelling, 20% chance of hemorrhaging on the poxes, 35% chance of blindness, 45% of pneumonia or severe lung problems, and 25% chance of death. The chances for these are separate, meaning that an unlucky infected person could potentially have all of them, I do suggest increasing the likelihood of death though for each additional extreme effect by +5%. For contact with infected it is defined as being in the same area with in 15ft, touching, being coughed on, and sharing a water or food source. If survived then a +5 CON resistance to reinfection.

Polio (Cure DC 20)

I'd play this maybe as a progression of symptoms rather then a hard nothing and then suddenly alot of things. Like if I rolled after the incubation period and got seizures and brain swelling I'd slowly ramp up the frequency of the seizures as the brain swelling got worse. You can even set a percentage amount for triggering the seizure during interactions with that NPC. This disease is really one you have to deal with for life unless magic intervenes in a big way, and I don't think everyone would be so lucky to receive that without some serious pushing by the party. Its something that wont kill a population in any extreme numbers kind of way but may completely cripple its people and in turn its kingdom.

This disease has no signs of sickness or outward signs of illness until it begins to cause extreme symptoms, this stage of incubation last 1d20 +2 days. During this time period the infected can pass on the disease through others coming in contact with their poop, or through coming in contact with contaminated food or water. Once the incubation period is over the disease lasts a lifetime unless cured by magical means and every 1d4 - 2 years can cause any of the following - permanent paralysis (20% chance) or spastic paralysis (35% chance), brain infection (15% chance) or brain swelling (40% chance), seizures (45% chance) and death (25% chance).

Yellow Fever (Cure DC 15)

Yellow Fever tends to hit hard and fast, you can be walking around fine one minute and completely laid out vomiting blood the next. The speed of it is often what terrifies, granted the bleeding from every where is also horrifying on so many levels. This is suppose to be a very terrifying thing to see happening around you as it spreads rapidly. Since its spread by animal and insect bites rather then contact with an infected person it is more random then most. This could lead to mass hysteria as everyone is trying to find what is causing it, blaming witches or pointing fingers as government officials scramble to hold someone or something accountable. In my opinion I'd suggest leaning into this and lead it down the path of rash decisions that either make the problem worse or create crazy new problems once the outbreak has been handled.

Survival of the disease means a lifetime immunity against that version as well as a +5 CON resistance to mutation variants. Infection happens through the bite of an infected animal or insect, with a 85% chance of infection. This disease happens in 3 short stages that last an average of 14 days. Stage 1 (1d4 +2 days) - no outward signs of infection, delay in felt symptoms as infection incubates and rapidly spreads. Stage 2 (1d4 days) - extreme vomiting, high fever, chills, delirium. Stage 3 (1d4 days) - Symptoms from Stage 2 carry over with the following symptoms possibly added heart failure (25% chance), liver failure (25% chance), kidney failure (25% chance), external hemorrhaging (35% chance), internal hemorrhaging leading to vomiting blood (60% chance), and death (55% chance).

Measles (Cure DC 12)

Here I would give a similar suggestion as I did with Smallpox because in the delay of knowing someone is infected. Really play into creating this paranoia with your players on not knowing who is and isn't sick. I would even sprinkle in some very close NPCs to the group they thought perfectly healthy suddenly being struck with the disease leading them to question if they too are infected.

This disease is extremely contagious (90% chance of infection) if come into contact with. For contact with infected it is defined as being in the same area with in 15ft, touching the creature or a contaminated surface previously touched by them, being coughed on, and sharing a water or food source. It lasts for an average of 24 days broken up into 2 stages. Stage 1 (1d10 +4 days) - no outward signs of infection as symptoms are delayed during incubation period where the person is still extremely contagious. Stage 2 (1d10 days) - blotchy red rash appears on body, high fever, coughing, pneumonia (35% chance), seizures (40% chance), blindness (15% chance), brain swelling (10% chance) and death (30% chance). The chances for these are separate, meaning that an unlucky infected person could potentially have all of them, I do suggest increasing the likelihood of death though for each additional extreme effect by +5%. If survived then a +5 CON resistance to reinfection.

Hookworm (Cure DC 10)

Its very likely you wouldn't know if you were infected with hookworms so this is probably the easiest RP of them all. All the NPCs act normal except that maybe they have some stomach issues and bathroom emergencies. So you know go about your normal business till you drop the magic mutation hammer of pain.

The disease is spread via contact with infected poop or contact with contaminated soil on bare skin. Mature parasites can penetrate skin only causing mild itchiness or a localized rash at the sight of entry. Infestation is not normally deadly but does continued until treated with medicine for 1d12 days or through magic means. Beginning infestation or mild causes show no signs but extreme infestations or late stage infestations (1d12 years) experience abdominal pain, diarrhea, loss of appetite, weight loss, fatigue and anemia with 35% gaining an intestinal infection from the occupation. Reinfection is very easy as no resistance is gained from defeating it.

I would be reminiscence if I didn't acknowledge that even mundane diseases mutate in mundane ways as well. Sometimes I keep these in as options during a disease outbreak sometimes I just skip right to the magic mutations. Even mundane mutations can be out there and very deadly but at least they can all just be a single roll chart. If you are going to do some mundane mutations I would suggest keeping them simple in that they add a single additional effect and make the cure DC harder. Anything more then that will make managing it a nightmare on your end especially if you want to add magical mutations. If its a single use in the campaign I wouldn't worry about making your mutation chart having more then 8 - 10 options, if it will be a regular occurrence in your game then at least 20 is my suggestion.

Lets say that viruses have a 20 - 30% of mutating in the first place and parasites have a 10 - 20%. If you hit a mundane mutation with your percentile dice you roll again as there are (in simplistic terms) 4 outcomes to a mundane mutation - it does literally nothing to the disease, small effect in the production of something, it is a detrimental mutations (meaning it kills those mutated ones off), or its a beneficial mutation that makes the new versions thrive. In hopes of keeping it simple 0 - 15% beneficial, 16 - 35% small effect in production, 36 - 50% detrimental, 51 - 100% it does nothing. But that could add up to a lot of dice rolls so my suggestion is every 1d8 days roll a percentile and only roll a beneficial mutation on 0 - 15% for viruses and 0 - 7% for parasites. Of course you can honestly just skip this whole bit and only do the magical mutations which I mean, who could blame you. They are way cooler to do.

Okay, now we are finally getting to the really good stuff. By this point you can also probably tell why this was broken up into a series since the length that has been acquired by tackling a single word in that 4 word series title. Let no one say I do not give a bang for your invisible none existent buck. When it comes to tackling this part I think of it in two large chunks - HOW the magic infects the magic to mutate it in the first place, and WHAT mutation the magic causes. You can see how one is very mechanically crunchy and the other can be more useful for RP purposes should your players try to investigate things.

When thinking about how magic can infect a disease a few examples float around in the back of my head. The first one being from one of my very favorite series, listed above the Circle of Magic is phenomenal, which gives a really interesting take on things. OBLIGATORY SPOILERS WARNING so you know SPOILERS SPOILERS SPOILERS. In the book someone improperly disposes of a failed magic mixture by dumping it down the sewers, this mixes with already existing water diseases and beefs it up to a crazy epidemic level. Looking at that case we can see that the point of entry for the magical mutation wasn't necessarily a direct attempt but rather negligence. We also see that because it was mixed into the water where the disease already was that it essentially just soaked it in magic. From there we can surmise that the magic that corrupted them probably got into it through osmosis before creating havoc in them. These all seem like nonsensical reasonings until your players decide they want to investigate things. Now you have a road map of clues and things they can pick apart and figure out in order to have a chance to reverse engineer a cure. Using another example from a slightly different source, ie I'm going to go off road for a second, we see how Parasitology Book 1 handles a break out of sickness via a parasite. So still technically a disease but one caused by a parasite so you know a little more complicated then straight viral sickness. Again OBLIGATORY SPOILERS WARNING so you know SPOILERS SPOILERS SPOILERS.  Within this world they have manufactured a parasite that when ingested shows as a symbiotic relationship. The host provides a safe home and in return never gets sick anymore, is super healthy, etc. But a something has been triggering things to go terribly wrong in those with these designer parasites, people start becoming mindless attack hordes. Turns out the parasite is more sentient then they thought and wants to take over. Crazy right? But JustKay what does this side ramble have to do with the magical corruption of mundane diseases? Well it goes to show that the effect can be something other then just a faster death for the host. Think what an unintended infusion of an awakened spell might do to such diseases that do involve parasites. If it is crafted and made that means it had a specific purpose created by a specific person. So it has a singular place of origin and a knowledge source to pull from when combating the outbreak. Don't feel like you have to limit yourself for either your starting disease (and cause) or your mutations. It might in fact be a cool opportunity for the DM and the players if you try something that might be slightly more complicated to tackle during the planning phase to really excite and horrify as the campaign progresses.

We've tackled a few examples of how the HOW can feed into the RP and investigation parts of your game. It doesn't have to be crazy detailed but you should know at least the source, how it came into contact with the disease, was it done with purpose or intent. Even just having a blurb or bullet point answering each of those 3 will let you easily field and handle most of the hard right turns your players can take when encountering these mutated diseases. Its now time to get into what those mutations can look like with the examples below. I've included 3-4 examples for each School of Magic in D&D 5e, to use these roll charts I suggest either picking the School of Magic for the mutation if you want that control or just rolling a d8. From there just simply roll the dice that is appropriate for the size of the list you put together. Typically I try and keep a list of 15 - 20ish for each School of Magic that I can pull from to make roll lists as needed. Lets dive into those and see if there is anything we need to unpack and attack with an explanation after the fact (that sounds like a sweet rap line when said out loud just FYI).

Abjuration (1)

1. Barrier (+3) - The infected seems to be sealed away in a body tight protection that can’t be broken. As the infection progresses this includes not being able to drink, eat, or deal with waste.
2. Absorption (+2) - Any liquid that the infected comes into contact with is sucked into their body, as the disease progresses the infected is unable to get rid of any liquid.
3. Reflection (+1) - Any physical touch or energy put to the infected has a chance of reflecting back. Roll percentile with 10% of activating, increase by 1% every day of the infection.

Conjuration (2)

1. Random Teleportation (+2) - Rolling percentile dice the chance of the infected person teleporting is 5% but increases by 1% each day they remain infected. A d4 or a d8 is rolled if the infected teleports to determine which direction it happens (N, NE, E, SE, S, SW, W, NW) and a d6 for how many feet (10ft - 60ft). Follow normal rules for teleportation into occupied spaces.
2. Frog in the Throat (+1) - Coughs up frogs every day, begin the dice at 1d4 for the frogs and increase for every week of infection.
3. Leaking Ick (+3) - The infected now is slowly leaking a poison through their pores, roll on a poison chart to find out what. The poison starts at ¼ power and increase 1d12 days of infection.

Divination (3)

1. Haunting Visions (+2) - The infected begins to become lost in visions of horrible scenes of people’s death and misfortune, these visions become more and more frequent until the infected is trapped in them.
2. Hyper Focused (+1) - Roll percentile dice, the infected has a start 5% to become lost from what they were doing and become hyper focused on an insignificant minuet detail or task (like getting all the grime off of an already clean glass). Add 1% for every 1d6 days of infection.
3. Ethereal Friends (+1) - The infected begins to see the Ethereal Plane overlaid with theirs, eventually it is more real to them. This pacing happens at the DMs discretion.

Enchantment (4)

1. Changing Mind (+4) - The infected memory is unreliable at best, new and different memories seem to be inserting themselves as old ones disappear. This can be done at the discretion of the DM but must increase in frequency until all memories are replaced if left untreated.
2. Disgusted Aura (+2) - If someone attacks within 30ft of the infected there is a chance that they become so disgusted by the infected that they attack them instead. The attacker must make a WIS DC save of 12 which increases by 1 every 1d4 days of infection.
3. Self Daze (+1) - Roll percentile dice, 15% and the infected’s speed drops to 0 and they become dazed for 10 minutes or until knocked out of it. Every 1d6 days the percentile increases by 1%, once you reach 100% begin increasing the duration or difficulty to knock the infected out of the daze early.

Evocation (5)

1. Shocking Touch (+1) - Once infected there is a 15% chance that you will cast Shocking Grasp on them. This chance increase by 3% every 1d6 days.
2. Burning Cough (+5) - The infected will begin to have a cough after 1d6 days that takes away 1d4 health each day of infection. After 1d10 days of infection smoke begins to pour from the infected’s mouth during coughing as magical fire burns in their lungs, increasing the damage taken each day to 1d8 until they reach 0 HP.
3. Sticky Hands (+2) - After 1d8 hours of infection the skin begins to be moldable like putty and stretchy, another 1d4 hours and the skin becomes sticky. Every 1d4 hours after that it becomes harder and harder to pry off of anything touched until you no longer can do so without ripping off skin.
4. Icy Fate (+5) - When caught in an infected person’s stare you begin to feel the temperature drop quickly as if it were winter. After 1d6 days the infected can’t get warm no matter what they do and begin to lose 1 DEX per day of infection, once it reaches 0 they are found frozen in place.

Illusion (6)

1. Many Selves (+1) - Roll percentile dice, on 5% the infected randomly has an illusion of themself split off from them and begin miming actions. Every 1d6 of infection +2% to chance of event happening. After 20 days the illusions begin to distort in size and shape.
2. Catching Dream (+2) - Each night the infected goes to sleep there is a 10% there dream will leak out and begin to warp the reality around them in a 5ft circle. Every 1d4 nights of infection the radius that this leakage affects extends 5ft.
3. Questioning Reality (+4) - Every 1d4 days of infection the infected begins to become increasingly paranoid that the reality they are experiencing is false, after 15 days there is a 15% they begin to become violent at the prospect of people trying to trap them in this false reality.

Necromancy (7)

1. Life’s Blood (+3) - The infected thirsts for blood and actually begins to lose 1 CON for every 1d4 days they go without it. After 1d6 days without fresh blood they begin to go through violent outbursts. After 1d8 days without fresh blood they go into a blind animalistic state until they have satisfied the thirst.
2. Ghostly Visits (+1) - An infected person attracts ghosts every 1d6 hours and are more susceptible to possessions. Those ghosts that can’t possess the infected instead begin to possess items and haunt the place they reside in. Use normal possession rules laid out by Ghosts in the Monster Manual, the infected's DC to save raises by 1 every 1d4 days of infection.
3. Wasting Away (+3) - Every 1d4 days the infected’s MAX HP decreases by 1. When it reaches 0 the infected collapses and begins to lose 2 CON every hour until healed. If they reach 0 CON then they die as the infection consumes their body.

Transmutation (8)

1. Uncontrollable Changes (+2) - Roll percentile dice, on a 10% the infected randomly polymorphs into something determine by rolling a dice on a roll list. Every 1d6 days this chance increases by +5%. The polymorph functions like the polymorph spell for its duration besides being unable to end it at will.
2. Stone Skin (+4) - A hardened shell of marble begins to spread all across the infected body and progresses each day of infection at a rate set by the DM, our suggestion is 2-5% every 1d4 days.
3. Thundering Noise (+1) - The infected’s voice begins to boom at an uncontrollable loud level for 1d10 minutes at 20%. After 1d8 days of infection add 5% per day.
4. Constant Sound (+1) - After 1d12 days of infection the infected begins to create an instantaneous sound that originates from a point of your choice within range, such as a rumble of thunder, the cry of a raven, or ominous whispers at 10%. After 1d4 days of infection add 5% per day.

Epidemics

Right so lets get into the last meaty bit - running these diseases on a massive enough scale to be considered an epidemic. Now the vocab around all of this can get a little confusing so I'm just going to steal some definitions from the CDC's and WHO's websites.

• Outbreak - "A sudden occurrence of a disease in a community, which has never experienced the disease before."
• Epidemic -  “The occurrence of more cases of disease than expected in a given area or among a specific group of people over a particular period of time.”
• Pandemic - "An epidemic that occurs across several countries and affects a sizable portion of the population in each"

With some terms laid out to play with we can actually already see a pretty simple map on what running something on a large enough scale would look like. As a DM we would progress it from outbreak, through epidemic, and then finally to pandemic proportions. In theory that is all well and good but what does that look like in practice? Lets take an example and run through it with some helpful hints and suggestions sprinkled throughout as I so often do.

A typical medieval city would have a population of lets say around 10,000. That's alot of people stacked on top of each other all bordered in by giant bricked walls. Now looking at that population size if suddenly 5 - 10 people got sick all with the same mutated thing we'd be entering our outbreak phase. During this time you need to think about how the city is set up social and governing body wise. Is the Lord/Lady/Lax of the city going to care if a couple of peasants are suddenly very ill with no cause known? What if it hit the more affluent and rich? Are there any hospitals or clinics that would be able to handle not only treating the disease but have the ability to find out what it is? If they have to call in healers to help solve it from far away then those healers are going to enter into a city with a lot more sick then when word was first sent. Figuring out your city set up in general happens when you make that city so you should have most of your answers, or at least vague hand waves you can solidify into answers. Once you have them now you know how a place will react the an outbreak and how quickly that might turn into an epidemic. In general based off of the population and where I start the disease making it progress into an epidemic is pretty easy. Lets take our 10,000 population size example city and say it starts in the slums where the poor are. Its a highly classiest city that likes to try and hide its poor districts behind veneers to attract tourists. There are no hospitals and only very small clinics as the city tends to favor its large pampering "health" spas and private doctors (for those who can afford it). I'll be a little generous and say 35% of the population live in squalor, 35% live poor lives, 20% live comfortable lives, and 10% are wealthy. That means we have 7,000 people immediately at risk with the illness (3,500 in squalor and 3,500 poor). They probably live right on top of each other, have poor hygiene, are often hungry, wear little more the cheap clothing or rags, and are ignored by the other 30% of the city. Roll a d10 to find the number of people suddenly sick in those districts. For each of those roll their contagious percentage rate, like in the case of measles we are talking 90% to infect. For each infection roll 1d4 for the first day, 1d6 for the second day, 1d8 for the third, etc. Once these numbers start getting large enough you can group up individuals to roll their contagious percentage rates together (ie rolling for 10 sick people at once).

When your infection rate in the two lower wards reaches 25% you now move into the epidemic phase. Now at this point in our examples city lets say its taken a week for this to happen. The governing body in the city has quarantined the poorer areas and unofficially decided to let it run its course, less poor after all means less unsightliness in their city. By this time it is too late since as soon as we hit 5% we started to roll to see if we infected anyone in the other parts of the city. With 1d10 +4 days without outward signs of sickness there was a week or more where everyone went about their normal business and jobs. The poor are tasked with things like cleaning the streets, manual labor, factory work, etc. So they came in contact with people on the streets, overseers at work and maybe even city watch. Every 1d4 - 1 days (minimum of 1) roll percentile to see if they come in contact with an infected person, 0 - 60% would be the middle class, 61 - 85% no one, and 86 - 100% the rich. When the middle class reached 5% infected then the likelihood of the rich being exposed to an infected would move to 71 - 100% as those that serve them (middle class) would now also be highly contagious.

Our imaginary city is a huge tourist spot with health spas, elaborate theater and music productions, fine dinning and immense art shows. So it stands to reason in the weeks before this turned into a few epidemic and the city began to quarantine all of its citizens rather then just the poor, that the sickness escaped the city. The unknowing tourist incubating the measles is now traveling in a carriage back home, a 3 day journey with a stop over in a town halfway between. They go to the bar to drink and get a hot meal before heading out again. Well those 3 - 5 people traveling via the carriage and driving it are definitely infected given our 90% contagious rate. If even just one person in that bar is infected that whole town is at risk. The infected's cup, plate, utensils, chair, table are all considered contaminated surfaces and can infected new people. So for this town we would start our infection in the working class, the middle class. Eventually when the infected person reaches home a sickness in the upper class, or wealthier parts of society would begin to get sick as they go about their life at social events and parties until Stage 2 of the disease. By that time though several people have begun traveling for the season that are now infected. That is how we reach pandemic levels. You can even have a visiting dignitary or ambassador become infected at a party and take it home. BOOM now its in another country, PAN-freaking-DEMIC.

Look disease and sickness in the real world is scary, its fast and sometimes it can seem random. That's what we want to go for when it comes to that in our game's as well. I know it looks like alot of work and dice rolls but having your players react in such a panic with alarming amounts of paronia makes it all worth it. Don't be afraid to use some or none of what I have suggested here. Make your own rules or short hands for infections. But remember to at least ask the questions needed to provide story and world tie in to keep it immersive. Have fun with the rules ya'll, after all it is a game.

With that little rambling over with, I’m JustKay your regular DM Dalliance on the web and I’ll see you next post.

PS - Come check out Part 2 of the series!