Illness in TTRPGs

Good evening everyone, a small update tonight as I’d hate to reset my steak so close to 500 nights in a row. Tonight the plan was to power through two Zine’s but for tonight we will have settle with a chat about Illness in TTRPGS. While I’ve stared at my Zines and fighting off a head-turning-chest infection it got me thinking. What about illness in TTRPGs?

Illness in TTRPGS

Now surely it cant be an uncommon concept. We have lingering injuries, scars, missing limbs and remediations for that. But what about other illness. In the DMG, Monster Manual and other core source books we find diseases and the “poisoned” status but it only sometimes feels impactful. But in a world where a Virus has swept across the globe and ravaged certain communities and in some cases leaving individuals feeling the lasting bite of its touch. What can we take away from this for our tabletop?

Maybe its not as simple as the poisoned condition lasting 24 hours. It’s been a hot minute that I’ve been able to bounce back after getting a code within one day. Maybe there is a lasting effect.

A simple, well perhaps simple, mechanism could be another pool for ‘wellness’ or ‘health’. Constitution governs HP and the ability to fight back against bugs, but why not expand this and have a simple measure. Constitution + Wisdom Mod + Level = Wellness.


The mechanics are then quite simple and scale well in a heroic fantasy world . The higher level, the more resilient of mind and body the less effected from common illnesses you are. If you rest adequately you recover, if you ‘take it easy’ you maintain a constant level, and if you over exert yourself then you get worse.

You only start to feel the effect if you at any stage would get to -1 on the scale, you suffer 1 level of exhaustion. If you are at 0 you are considered Poisoned until you long rest. If you are 2 or higher then you are fine. Doesn’t sound too horrible or game breaking but at level 1, assuming that people don’t take Constitution as a dump stat, you can expect somewhere between 1 and 6 as your wellness meter. As you level up you could have the top end be as high as 30 and still have the lowest being 21.

This is a large buffer before you get negative side effects. But how do we get that?

Eating undercooked or poorly prepared food. Bitten by a creature such as stirges, ghouls, zombies, skeletons, rats, or anything that may carry a disease or something. Exposure to plants, rules, a spell, a waft of perfume from Aunt Hilda, she has the worst taste in these things. The list of what could cause the initial disease is long and extensive as our imaginations but how could that play with the tracker?

Rest is best

Now to key to something like this isn’t to punish the players for.. playing the game. But if they fail a Constitution save then they would progress one down as the stress on their body continues. If they are suffering from illness and they are reduced to half HP then after combat they would need to make a con save or drop again. Not spending 1 hit dice on a short rest, also drops and if they don’t have a long rest, unbroken (not on watch duty) at least once a day they also drop down.

However if they receive any healing they would maintain their current level regardless of the above conditions. If they get a full long rest that is unbroken they would go up on the scale. Resting, long rest and short rests, frequently would see the pool increase until you get to max+1 at which point you recover from the illness.

This means that after most encounters with a source of illness, if treated correctly (medical supplies or healing spell) AND you have a long rest, you wont notice it at all… But when you tie this in with lasting injuries and other such mechanics the consequences could be quite intense.

Thanks for joining me tonight for this little musings session. Don’t forget to come back this week as we power onwards for more adventures and, hopefully, I manage to get a few long rests in and recover myself. And as you consider putting constitution as your dump stat, when you go to roll a CON save I would ask you to don’t forget to roll with advantage,
The Brazen Wolfe