file0001351763534If you would like a printable version of this post for quick reference, I organized it into a PDF which you can find here.

I have recently become intimately aware of the extreme effects of having sickness ravage my body. It is the same kind of awareness I gain after most conventions I go to, or when travelling by airplane. Anytime I’m exposed to masses of people and am putting even just a moderate amount of energy into travelling or socializing/working, that con-crud, nasty flu of the week that’s been going around, or common cold seems to edge in past my defenses and start trying to knock me down. Sometimes, I get a little bleggh for a couple of hours and my body prevails. Sometimes though, my body loses and I end up confined to my bed barely able to move, aching and moaning like my life is about to end. This was my experience for the last week and is the effect sickness has in my normal, modern, cushy, comfortable, and clean lifestyle. Can you imagine if I were an adventurer in a game facing constant stress, combat, and not having time to rest and recover?

Sickness in most games is something we rarely look at, mostly because it isn’t easy to accurately reflect the process in the mechanics (and because it is pretty gross to roleplay). However, it can have some fun effects on a game if done correctly. Thinking on my recent sickness, I’ve tried to model a system that can help you simulate the common effects of sickness for any game system.

The Infection Event

Any sickness or disease starts with infection or an event that creates it. There are many ways that a character could get infected with a disease.

  • Exposed to a harmful biological agent (fungus, poison, etc.) that weakens the immune system or causes the infection itself.
  • Cuts or scrapes during combat that open the way for infection. (Many armies dipped arrows in dung to try to spread infection.)
  • Bites from animals or monsters.
  • Extreme weather conditions, stress, malnourishment, or some other factor that weakens the immune system.
  • A close friend or fellow adventurer is infected and spreads it on.
  • Contact with a particularly sick person. Even mild exposure to bodily fluids can open the way to infection.

When a character is exposed to an infection event that you feel might be likely to pass the infection on:

  • Have them roll (or roll on their behalf) an appropriate physical toughness roll to see if they pick it up.
  • Set an appropriate difficulty based on your system for how likely it is to be infectious.
  • Repeat this roll as needed while the person is still in contact with the infection or for a few times after the event that caused infection.
  • Make more frequent rolls if the event is something like an animal bite or cut or scrape that is not properly taken care of and bandaged. This can make damage in combat more realistic and deadly.
  • If the character fails the roll and becomes infected, then you can use the next two sections to determine how long it lasts and what symptoms and mechanical penalties they have.

Length of Infection and Getting Over It

The character has been infected with the disease and is showing symptoms. Now you get to determine how long this will last. If you have a disease in mind (like the common cold), then you can look up real world information to see how long they usually last. Most diseases last 2 to 4 days, depending on their strength and the person fighting them off. Decide how long each phase of the disease is going to last and enter the information into the following chart. Use 1/2 day, 1 day, and 2 days for the length. At the end of each day, the character makes an appropriate toughness roll to see if they move on to the next phase of the disease, go back to a previous phase, or defeat the disease completely. If they don’t succeed, move on after the appropriate time.

Phase of Disease Length Of Time Difficulty Of Toughness Roll
First Phase
(Few to no symptoms, mild and expressed through roleplaying but not penalties.)
# of days _______
(should be short, a day or two at most, unless the disease has a long gestation)
Very High – The disease is taking hold but your body hasn’t yet gone to war against it, so its defenses aren’t yet causing symptoms to fight it off. If successful on this roll, skip Second Phase and go to Third Phase
Second Phase (Symptoms are getting worse and now cause penalties.) # of days _______
(a day at most, unless the disease takes a while to fight off or is severe)
High – Your body is fighting now and starting to cause symptoms, but the germs, bacteria, and viruses are not yet stymied. If a roll is successful here, immediately move to the next phase. An incredible roll will likely move you to the End Phase. A botch here might double the length of time.
Third Phase
(Symptoms are at their apex and cause penalties, but some symptoms are going away.)
# of days _______
(a day or three at most, unless the disease takes a long while to fight off or is severe)
Medium To Low – This is when symptoms are the worst, but your body is winning. A roll here will cure the disease and push it out of your body completely. A botch here might send you back into the second phase.
End Phase
(Symptoms have mostly gone and penalties are not assessed, only roleplayed.)
# of days _______
(two to three days of mild annoyance that your body has not yet kicked it, but this is all roleplaying)
None – You’ve beaten it, but… your body is still on high alert and you get a few aftershocks of your symptoms.

 

Symptoms

Ok. This is the fun part. Once the character has gotten into the second phase of the sickness and is now actively fighting it off, then the symptoms start hampering them.  I’ve made 3 charts for basic styles of gameplay and I’ve made symptom penalties at mild, moderate, and severe levels. This should provide enough flexibility to model the disease in your system. You can use these as you like. Here are some notes/options/suggestions.

  • Determining Which Symptoms Affect The Player – You can either choose 2 or 3 symptoms that are relevant to the disease and assess penalties on those. You might roll a d10 a few times to determine which symptoms are severe enough to cause penalties. You might roll percentage dice for each symptom to see if the character picks it up, i.e. there is a 20 percent chance of fever/chills, roll percentile dice and see if they get that penalty as part of their disease or not. Move on to the next one.
  • Mix and Match – Perhaps the character has a mild cold with mild headache, mild paleness, and mild fever/chills. Perhaps the character has a cold with mild headache, severe nausea, and moderate coughing fits. Determine how you want your disease to function and apply the penalties.
  • Roleplaying vs Penalty – Most symptoms should be roleplayed with only 2 or 3 symptoms being assessed as mechanical penalties. Additionally, most penalties should only be assessed during moments of high stress, vigorous action, or when it is important to the story.
  • Modifying Penalties – Modify the penalties to fit whatever is appropriate for mild, moderate, and severe penalties in your game system. I’ve tried to model 3 types of systems for your use, but you will likely be using a system that is different from this and will have to do the last mile of work to make it match up appropriately.

 

Games with Single Die/Set Difficulty (D&D, Pathfinder)

 

D10 Roll Symptom Penalty
1 Fever/Chills
Your body feels incredibly hot and sweaty or frozen and unable to get warm. Sometimes, you will switch between these within a matter of minutes.
Mild: Your body is uncomfortable and cannot get its temperature equalized. Thus, your natural health level is at 75% of its normal rate. This does not count as physical damage, so penalties from such would not apply.
Moderate: Natural health 65% of its normal rate.
Severe:
Natural health 50% of its normal rate.
2 Nausea
Everything sets off a feeling of Nausea in your stomach and throat as bile attempts to escape through any hole available to it.
Mild: Any rigorous movement/action causes you to make a toughness roll at low difficulty to keep your insides on the inside. If you fail, you suffer the effects of #5 – Indelicate Emissions.
Moderate: Toughness roll is at medium difficulty.
Severe: Toughness roll is at high difficulty.
3 Coughing Fit
Your lungs have decided there are things in there that they don’t want and have taken massive effort to evict everyone.
Mild: At the start of any high stress or very active situation, the character rolls a toughness check to see if they are able to suppress their coughing. If not, then they take a +2 hindrance to the target number of all actions during the scene.
Moderate: +4 hindrance
Severe: +6 hindrance
4 Lethargy/Lack of Strength
Your body just doesn’t want to work correctly. Your muscles are on break, even to the point that without dedicated effort you stumble around as your legs try to fail underneath you.
Mild: Cut all movement & initiative bonuses in half/add +2 hindrance to the target number of all rolls regarding anything physical.
Moderate: +4 hindrance
Severe: +6 hindrance
5 Indelicate Emissions
The contents of your stomach try to surf the esophageal curl to the outside world.
Mild: There is a 10% chance during each round of a high activity/stress situation that you will unwillingly retch. If this occurs, you are incapacitated for that round, cannot move, and are vulnerable to any attack. (Sneak attacks are automatic, lose armor/dexterity bonuses, etc.)
Moderate: 20% chance
Severe: 40% chance
6 Paleness/Rash
Your disease has affected your skin and drained all color, left you with spots, or made your skin red and blotchy. You are no longer the face of the group.
Mild: +4 hindrance to the target number of all social/charisma checks until your vitality returns.
Moderate: +4 hindrance
Severe: +6 hindrance
7 Congestion/Breathing Difficulty
The roadways to your lungs are blocked and you must extend massive effort to pull air into your body.
Mild: Cut all movement & initiative bonuses in half /+2 hindrance to the target number of all toughness or strength rolls.
Moderate: +4 hindrance
Severe: +6 hindrance
8 Headache
There is a small gnome inside of your head playing the timpani and bass drum sections of Also Spoke Zarathustra.
Mild: +2 hindrance to the target number of all perception & noticing types of checks.
Moderate: +4 hindrance
Severe: +6 hindrance
9 Dizziness/Mental Fatigue
Your brain is… wait, oh. Sorry … not … thinking…good now. Please stop spinning the room so I can … sentence… build
Mild: Your brain is not working right, thus any intelligence or knowledge bonuses to rolls are negated and mental skills (such as spells, psychic powers, etc.) have a 20% chance of failure.
Moderate: 40% chance
Severe: 60% chance
10 Sleeplessness/Lack Of Appetite
The multiple symptoms of your body are not letting you get any rest at night, nor are they letting you get sufficient food into your system to recharge.
Mild: Any natural healing of physical damage is 1/4 less while you are sick and unable to rest.
Moderate: 1/2 less
Severe: All natural healing is negated

A Final Additional, Catchall Symptom – Depending on the type of sickness, it could affect the hit points of a character directly. Each day the character suffers, they lose a set amount of hit points or health levels. This makes the symptoms much more deadly, especially when combined with other symptoms and a long sickness.

Games with Different Dice For Each Roll (Savage Worlds, Cortex)

 

D10 Roll Symptom Penalty
1 Fever/Chills
Your body feels incredibly hot and sweaty or frozen and unable to get warm. Sometimes, you will switch between these within a matter of minutes.
Mild: Your body is uncomfortable and cannot get its temperature equalized. Thus, your natural health level is at 75% of its normal rate. This does not count as physical damage, so penalties from such would not apply.
Moderate: Natural health 65% of its normal rate.
Severe: Natural health 50% of its normal rate.
2 Nausea
Everything sets off a feeling of Nausea in your stomach and throat as bile attempts to escape through any hole available to it.
Mild: Any rigorous movement/action causes you to make a toughness roll at low difficulty to keep your insides on the inside. If you fail, you suffer the effects of #5 – Indelicate Emissions.
Moderate: Toughness roll is at medium difficulty.
Severe: Toughness roll is at high difficulty.
3 Coughing Fit
Your lungs have decided there are things in there that they don’t want and have taken massive effort to evict everyone.
Mild: At the start of any high stress or very active situation, the character rolls a toughness check to see if they are able to suppress their coughing. If not, then the die type is reduced by 1 level for all rolls during that scene.
Moderate: die type reduced 2 levels
Severe: die type reduced 3 levels
4 Lethargy/Lack of Strength
Your body just doesn’t want to work correctly. Your muscles are on break, even to the point that without dedicated effort you stumble around as your legs try to fail underneath you.
Mild: Cut all movement & initiative bonuses in half /On all physical action checks the die type is reduced by 1 level for the roll.
Moderate: die type reduced 2 levels
Severe: die type reduced 3 levels
5 Indelicate Emissions
The contents of your stomach try to surf the esophageal curl to the outside world.
Mild: There is a 10% chance during each round of a high activity/stress situation that you will unwillingly retch. If this occurs, you are incapacitated for that round, cannot move, and are vulnerable to any attack. (Sneak attacks are automatic, lose armor/dexterity bonuses, etc.)
Moderate: 20% chance
Severe: 40% chance
6 Paleness/Rash
Your disease has affected your skin and drained all color, left you with spots, or made your skin red and blotchy. You are no longer the face of the group.
Mild: +2 hindrance to the target number of all social/charisma checks until your vitality returns or die type is reduced by 1 level for the roll.
Moderate: +4 hindrance / die type reduced 2 levels
Severe: +6 hindrance / die type reduced 3 levels
7 Congestion/Breathing Difficulty
The roadways to your lungs are blocked and you must extend massive effort to pull air into your body.
Mild: Cut all movement & initiative bonuses in half /+2 hindrance to the target number of all toughness or strength rolls or die type is reduced by 1 level for the roll.
Moderate: +4 hindrance / die type reduced 2 levels
Severe: +6 hindrance / die type reduced 3 levels
8 Headache
There is a small gnome inside of your head playing the timpani and bass drum sections of Also Spoke Zarathustra.
Mild: +2 hindrance to the target number of all perception & noticing types of checks or die type is reduced by 1 level for the roll.
Moderate: +4 hindrance / die type reduced 2 levels
Severe: +6 hindrance / die type reduced 3 levels
9 Dizziness/Mental Fatigue
Your brain is… wait, oh. Sorry … not … thinking…good now. Please stop spinning the room so I can … sentence… build
Mild: Your brain is not working right, thus any intelligence or knowledge bonuses to rolls are negated and mental skills (such as spells, psychic powers, etc.) have a 20% chance of failure.
Moderate: 40% chance of failure
Severe: 60% chance of failure
10 Sleeplessness/Lack Of Appetite
The multiple symptoms of your body are not letting you get any rest at night, nor are they letting you get sufficient food into your system to recharge.
Mild: Any natural healing of physical damage is 1/4 less while you are sick and unable to rest.
Moderate: 1/2 less
Severe: All natural healing is negated

A Final Additional, Catchall Symptom – Depending on the type of sickness, it could affect the hit points of a character directly. Each day the character suffers, they lose a set amount of hit points or health levels. This makes the symptoms much more deadly, especially when combined with other symptoms and a long sickness.

Games with Multiple Dice Of Same Type (WOD, Shadowrun)

 

D10 Roll Symptom Penalty
1 Fever/Chills
Your body feels incredibly hot and sweaty or frozen and unable to get warm. Sometimes, you will switch between these within a matter of minutes.
Mild: Your body is uncomfortable and cannot get its temperature equalized. Thus, your natural health level is at 75% of its normal rate. This does not count as physical damage, so penalties from such would not apply.
Moderate: Natural health 65% of its normal rate.
Severe: Natural health 50% of its normal rate.
2 Nausea
Everything sets off a feeling of Nausea in your stomach and throat as bile attempts to escape through any hole available to it.
Mild: Any rigorous movement/action causes you to make a toughness roll at low difficulty to keep your insides on the inside. If you fail, you suffer the effects of #5 – Indelicate Emissions.
Moderate: Toughness roll is at medium difficulty.
Severe: Toughness roll is at high difficulty.
3 Coughing Fit
Your lungs have decided there are things in there that they don’t want and have taken massive effort to evict everyone.
Mild: At the start of any high stress or very active situation, the character rolls a toughness check to see if they are able to suppress their coughing. If not, then they remove 2 dice from any roll during the scene.
Moderate: Remove 3 dice
Severe: Remove 4 dice
4 Lethargy/Lack of Strength
Your body just doesn’t want to work correctly. Your muscles are on break, even to the point that without dedicated effort you stumble around as your legs try to fail underneath you.
Mild: Cut all movement & initiative bonuses in half /Remove 2 dice from any roll involving a physical action.
Moderate: Remove 3 dice
Severe: Remove 4 dice
5 Indelicate Emissions
The contents of your stomach try to surf the esophageal curl to the outside world.
Mild: There is a 10% chance during each round of a high activity/stress situation that you will unwillingly retch. If this occurs, you are incapacitated for that round, cannot move, and are vulnerable to any attack. (Sneak attacks are automatic, lose armor/dexterity bonuses, etc.)
Moderate: 20% chance
Severe: 40% chance
6 Paleness/Rash
Your disease has affected your skin and drained all color, left you with spots, or made your skin red and blotchy. You are no longer the face of the group.
Mild: Remove 2 dice from all social/charisma checks until your vitality returns.
Moderate: Remove 3 dice
Severe: Remove 4 dice
7 Congestion/Breathing Difficulty
The roadways to your lungs are blocked and you must extend massive effort to pull air into your body.
Mild: Cut all movement & initiative bonuses in half /Remove 1 dice from all toughness or strength rolls.
Moderate: Remove 2 dice
Severe: Remove 4 dice
8 Headache
There is a small gnome inside of your head playing the timpani and bass drum sections of Also Spoke Zarathustra.
Mild: Remove 1 dice from all perception or noticing things type of rolls.
Moderate: Remove 2 dice
Severe: Remove 4 dice
9 Dizziness/Mental Fatigue
Your brain is… wait, oh. Sorry … not … thinking…good now. Please stop spinning the room so I can … sentence… build
Mild: Your brain is not working right, thus any intelligence or knowledge bonuses to rolls are negated and mental skills (such as spells, psychic powers, etc.) have a 20% chance of failure.
Moderate: 40% chance of failure
Severe: 60% chance of failure
10 Sleeplessness/Lack Of Appetite
The multiple symptoms of your body are not letting you get any rest at night, nor are they letting you get sufficient food into your system to recharge.
Mild: Any natural healing of physical damage is 1/4 less while you are sick and unable to rest.
Moderate: 1/2 less
Severe: All natural healing is negated


A Final Additional, Catchall Symptom – Depending on the type of sickness, it could affect the hit points of a character directly. Each day the character suffers, they lose a set amount of hit points or health levels. This makes the symptoms much more deadly, especially when combined with other symptoms and a long sickness.

Roleplaying & Reward

You’ve got a sickness mapped out in number of days and rolls to get over it. You’ve cackled maniacally as you set up symptoms to watch your players deal with them. Now lets talk about making playing out a sickness fun. Being sick is absolutely no fun, but playing it out shouldn’t be the torture of the real deal. How can that occur when you are leveraging penalties on the players? Well, the answer is simple – make sure it doesn’t sting too much (unless that is the intent) and make sure there is some reward to counterbalance the penalties you are leveraging.

  • XP Reward – In return for playing out this sickness and dealing with the penalties, grant a bonus to sick characters. A moderate amount of XP for roleplaying in each session so that the sting of the penalties is gone. You can even grant this bonus XP to the other players who have to expend more energy taking care of the sick character.
  • Roleplaying Opportunities – Emphasize how the roleplaying of this sickness can provide a lot of fun opportunities. The other characters will have to take care of the sick person. It could open up new storylines between characters or, depending on your style of play, it could be the extra hardship that your character rises above. If a character gets sick in the game, the next quest could be to find appropriate medical care or an antidote and these rules would make that quest feel justified. Making characters sick during a moment where they can’t afford to be (such as being in the wilds pursued by the orcish army and the sickness makes them unable to run away) can increase the sense of danger. If your campaign revolves around a sickness or plague, then using this system can make that danger feel very relevant.
  • Justified Penalties – You can utilize this system when something occurs that would make the character sick and they botch on a roll. Replace a square on the critical hit chart with infection. Warn them that their might be penalties for “fraternizing” with the alien race, then have them make their resistance roll. If you play this as a straight up penalty, but it is justified by something in the game, then it is less annoying to suffer through this.
  • Making Healing Skills Matter – Have you got a character with some healing or alchemy skills? Make them matter in a big way by making most of the party sick and having their medicines reduce penalties/allow the group to go on.
  • You Knew The Risk – Another roleplaying avenue for this is to make the sickness a risk of some greater challenge. Perhaps staying by a beloved NPC’s bedside exposes the character. Perhaps journeying into the catacombs is known to cause sickness. If the players are warned and you mention you’ve got a system to model the sickness, then they know what they were getting into. You can give them one burst of bonus XP or grand prizes in the game for risking life and limb and overcoming another challenge.

Final Notes

3481163841_8c1a1a8f5bI tried to make this system something that modeled the actual symptoms of sickness and getting over it, not the sort of thing that penalized attributes at their source or was a list of very rare diseases. I also tried to make it work in the system you are playing in right now by providing multiple options. Sickness in the real world is something that knocks you out but good, but then you get over it. This I know from my personal experiences of the last week or so. Imagine that applied to people leading much higher stress lives.

This system is the sort of thing that should be used sparingly, but it can make a disease in a game feel relevant and challenging like it feels in real life. I hope it might be of use to you in an upcoming game, and I’d love to hear your thoughts. Do you have a favorite disease system in a game? What works well about it? Have you ever used anything like this as a game master or do you just hand wave over sickness?

 

About  John Arcadian

John Arcadian is the head of Silvervine Games, a freelance writer and art director, a website developer, a builder of sonic screwdrivers, and a purveyor of kilted mayhem. When he isn't out causing trouble in his kilt... Well, no, that is pretty much what he does when he isn't running RPGs or or trying to take over the world.



16 Responses to Modelling Sickness In A Tabletop RPG

  1. While *having* an invalid in the party is a legitimate and interesting complication, *being* said invalid is something you could have stayed home for. Which brings me to my point – there’s always a time when everyone couldn’t make it to the game. As long as it isn’t someone the rest of the party would rather toss off a cliff, this is a good victim for your illness. The rest of the party can feel good about taking care of them, but their player isn’t in for an evening of thumb-twiddling.

  2. Walt Ciechanowski

    Great article!

    Don’t forget the effect on skills – a nasty cold or phlegm in the throat may not significantly affect your “toughness”, but try making a Charm check with a runny nose or a Stealth check while coughing up.

    In some cases this could be a bonus, as someone trying to avoid catching what you have by just giving you whatever it takes for you to go away.

    • Thanks. Yeah… I was looking at some of the stuff with penalizing skills but decided to leave it out so the sickness rules could be used in more systems.

      I did think about using a sick NPC or character as a plague-bearer in strategies against an enemy. Sure I’ll go help the duke. Hope he doesn’t feel too run down as I spread the disease.

  3. As a regular WFRP GM I can tell you that characters in the Old World do get infected with illness & disease on occasion, so I really like what you have done here. However, in games where every street corner has a healing temple or apothecary, sickness is usually not much of an issue.

    • Thanks! Yeah. Sickness can get overturned pretty easily, and this gives a little more relevance to the healers and sickbays of RPG worlds. What are WFRP’s systems to deal with sickness? I built this one because I disliked the D&D options and couldn’t find too much else that I liked for dealing with sickness on my RPG shelves.

      • WFRP deals with sickness/disease in a very medieval way. i.e. if the sickness/disease doesn’t kill you, the cure just might. Being infected with sickness/disease in WFRP is generally treated as a roleplaying opportunity (akin to insanity) not only for the player who portrays the infected character but also for the GM who can use it to drive a side quest for a treatment.

        Mundane treatments are fairly common, but often dangerous. Magical treatments are more rare, but getting to them can be the dangerous part, especially if time is critical.

        I’ve run two WFRP campaigns in which there was a plague spreading through parts of the Empire. In one campaign the plague eventually became the central focus of everything and in the other it was merely window-dressing. Both games were great fun.

        I think the real secret is to use illness/disease sparingly amongst the PCs, but when it does happen play it for all its worth. YMMV.

  4. A lot of systems have illness and disease, but most players I’ve known have skipped over it because it’s not fun to have your character laid low. Not too many of them have been overly into story as much as adventure, though.

    • Very true. Having a player completely out of a game sucks ass. I plan to use this in an upcoming game for one session, mostly to give them an interesting take on getting sick because of a monster or a misstep into an old ruin. It’s definitely not the sort of thing to overdo in a game.

      I do have to thank my current GM for part of this. He has been running his current game in an old-school adversarial style, and while I was sick I got to wondering how he would run that in his game and make it matter, not just be a “Meh, you take -2 to everything, play it up.” situation where it didn’t feel like my character had any reason to act out the effects of being sick.

  5. Awesome-sauce, sir. It’s a systematic yet simple method of dealing with disease that still holds an excellent degree of verisimilitude. Well-crafted mechanics.

    I’ll be using this as inspiration for handling illness in my own system. Thank you.

  6. While playing a phone app called Plague Inc. I saw a complete list of transmission vectors, symptoms and abilities for the disease you create. I think it could be added to this excellent system you created…

    Vectors include birds, rats, mosquitoes, livestock, blood, water and air (as you progress, additional vectors open up to contaminate more people)

    Symptoms (32 from mild to horrific) are included in this link : http://www.plaguetips.com/p/symptom-encyclopedia.html
    this gives more deadly options for GMs wanting to create something truly nasty…

    Special abilities for the disease include resistance to cold, heat, drugs and general environmental hardening.

    I think i’ll switch the symptoms list from your list for the one from the game… I wonder the DC for avoiding “projectile vomiting”… <>

    And I apologize if anyone is offended by my suggestion…

    • Nice Find Eric!

      I like those as an expansion for this kind of sickness modelling. It might be too much for most systems, but if you are looking for a very detailed approach, such as the kind you would use in a plague based game or when the PCs contact some very specific type of illness, those would be a great place to go.

  7. I… appreciate the cause that inspired your research. I recognize a few of those symptoms.

  8. All this because you failed three straight Vigor rolls?

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