To be fair, it’s super easy to pour fluids down a void zombie’s throat. Lots of real estate to aim at. Not that it’s particularly advisable to do so. You just know that background akata is waiting for Street Samurai to make a “treat disease” check and let her guard down.

Any dang way, if you haven’t tried out the Dead Suns adventure path over in Starfinder, they got some actually-deadly diseases to worry about. Coming over from Pathfinder 1e, my group was taken aback to discover how low-level afflictions were a bigger deal than the filth fever of yore. Rather than taking a manageable penalty to an ability score or two, PCs were suddenly progressing down something called “the Physical Disease Track”. You can follow that link down the rules rabbit hole if you like, but trust me when I say that’s not a track you want to be on.

I’ve got some sympathy for game designers here. The deadliness of afflictions is not an easy needle to thread. On the one extreme you’ve got the “oops you’re dead” style made famous by rot grubs. On the other end of the spectrum is the unimpressive inconvenience of medium spider venom. And you’d better believe that there’s plenty of design space in between.

Beyond the variability of penalties inflicted, there’s also the question of a cure. Make it too easy to down a potion of “poison doesn’t matter” and your affliction ceases to be a meaningful threat. Then again, if you restrict access to antidotes, players might have to go multiple sessions with a crippled character. That’s doubly true if you’re running a wilderness adventure without easy access to medical care.

In my own view, the most fun you can have with a disease is a half session or so of “fighting wounded.” It’s the same trope as John McClane getting in shootouts with bleeding feet or Korra trying to finish her duel before the poison kills her. There’s a ticking clock element to these sequences, and watching our heroes make it through on grit and force of will is a rewarding narrative. We’re playing games rather than watching movies though, and that means my ‘optimal scenario’ is hard to dial in with random saves and variable DCs in the mix.

All of the above is my attempt to lay out the problem space. Diseases can differ wildly in effect, ease of cure, and intended play experience. If you’re chucking dice in something like Warhammer Fantasy Roleplay rather than D&D, you’re going to have a VERY different experience at ye old doctor’s office. I’d therefore be curious to hear how the rest of Handbook-World likes to play it. Is there a system that manages to get the deadliness of diseases right? What’s the most fun you’ve ever had using afflictions as a plot device? How did that space goblin stuff its head into that helmet? For all of the above, hit us with you own disease-ridden opinions down in the comments!


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