From the black death, Mummy Rot and the dreaded Green Jelly, to scurvy and Covid-19, Sickness and disease are a reality of both the real world and the fantasy one alike. But how do you go about including illnesses in your D&D game, especially in times like these where the subject could be a little touchy?

D&D takes plagues to a new level (art by Hoken4500 )

Fantastic plagues and where to find them

The truth is, even in our modern age of vaccines and metropoliptic hygiene infrastuctures, contagions are still a facet of everyday life. Even if we ignore the mass hysteria our latest pandemic of [Covid-19, H1-N1, insert this year’s dread virus here], the common cold, cancer, hangovers and bad pork are still a reality. While the subject may be unpleasant in and of itself, it does give us one relatively small silver lining – it gives us DM’s a whole new kind of threat to work with.

Since modern medicine hasn’t fully caught up to all the little microbes that can kill us, or just leave us projectiling from both ends of our body, one has to imagine that it’s far easier to get sick in a world where people travel for weeks without seeing civilisation, and even when they do, only the largest towns have anything even vaguely resembling a sewer system! In the world where the guy saying “ten likes and prayers to Pelor” is actually the most qualified healthcare professional around. Where rats the size of cows aren’t restricted to New York and you regularly encounter creatures with diseases named after them (see, demon fever, mummy rot).

Vomit pouring through a knight's helmet
Remember to lift your faceplate before spewing

Including diseases in your game is great for immersion – it adds another layer of detail into the world, one closely tied to everyday life in the adventuring world, and also can bring some of the subtler fantastic elements to the fore – especially when you consider how a cleric can heal diseases with a touch, and how your soon-to-be ailing players contracted them in the first place…

Where did you come from, where did you go?

Infections affecting your players need to come from somewhere. Whether environmental (jungle fever), transmitted (mummy rot), or sexually transmitted (green jelly, the herp), explaining how a character gets sick, or rather, creating a threat that could potentially get a character sick, is a great opportunity for a bit of story telling. Your players could happen upon a village full of people suffering the aftermath of a contagion curse, and charge the players the task of finding the one responsible. This could lead to the players catching the plague, or safely finding the oncomancer (Best class to come out of the Book of Vile Darkness) and curing the village. They could even discover that they all deserved it somehow.

Warcraft meme - Arthas purges a diseased city
Little trigger-happy, there, Arthas

The type of infection determines how your players are at risk of getting exposed. Travelling through a swamp or jungle could easily get them a blood disease via a mosquito or leech. Slums are often rife with various colds, flus and bugs (both literal and tummy bugs). You could finally slow the bard’s roll with an STD or two – you could get especially creative with this when the inevitable “I roll to seduce the dragon” shoutout comes. And once the draconic herpes set in, you’re pretty much stuck with them, and your players will have to learn to live with it…

Living on a prayer

Nun counting likes and prayers for a diseased child
D&D’s clerics take a slightly more active role than this…

We often see jokes about how many likes or prayers it takes to cure a plague or disease in real life, and while it’s easy to scoff at the idea, for the ones living with it every day, it’s probably a way of living with it. Your infirmed players, who at least have the real option of seeing a priest, will also have to live with whatever you throw at them, assuming it doesn’t kill them outright. Diseases can be a nuisance, or they can be debilitating, but they’re so much more than just a stat debuff and a few fort (or con) saves every few hours.

Zombie on the ground reaching forward
ACTUAL footage of me with a cold

Diseases come with symptoms. Remember the last time you felt really sick? Did you feel like your con and strength scores had just taken a bit of a knock, or did you feel absolutely fucking awful? I know I get irritable and sleepy when I’m sick, even when the illness itself isn’t known to have those symptoms. When describing an illness to your players, don’t just tell them about their stat drops. Maybe don’t tell them at all until the symptoms clue them off. A common practice is to simply inform the player that they’re feeling feverish and sore, or otherwise describe their symptoms. And with those descriptions, is where the fantastic diseases really shine.

I’ve got a strange disease…

As with anything in D&D, illnesses aren’t as mundane as mere sniffles and sneezes. Diseases in the fantasy world are fantastic. From a disease that causes uncontrollable laughter to a ghoul’s paralysis, which can cause your corpse to rise as an undead creature, the illnesses in D&D are truly strange. Depending on the atmosphere of your campaign, a disease can be hilarious, terrifying, or an emotional roller-coaster.

Person turning into a werewolf
Lycanthropy: Technically a disease.

While the ruleset in 5e hasn’t yet gotten too deep into diseases and how they work, most of the disease rules from 3.5 port over quite seamlessly – just roll con saves instead of fort and you’re good.

Attractive female bard plays for a crowd
Remember, kids, always use protection spells, especially when the bard’s involved.

If you’re struggling to find a disease that fits your context, you can always homebrew one – I got my first party’s bard and barbarian to slow down (though, nothing could ever stop them outright) by letting them contract a venerial disease I cooked up, called “The Green Jelly”. It’s exactly what it sounds like, fluids turn into an apple-flavoured, gelatinous green substance. That was when I realised that the sky is pretty much the limit.

Much like my bard and their new apple-custard restaurant business, the most important part of a disease in D&D is how you deal with it.

The Cure

Picture of The Cure
Sorry, couldn’t resist

Unless they somehow spin it into a lucrative culinary business, chances are your players are going to want to get rid of their plagues, infections, diseases and parasites. Remember how I mentioned likes and prayers earlier? That’s actually the most efficient way to do it in D&D – clerics get their restoration spells straight from their deities. It’s simply a matter of finding a willing cleric. Honestly, check it out:

Lesser Restoration Spell Card

A 3rd-level cleric can cast it. 3rd-Level! But there are some interesting points there – the spell can “end one disease”, not necessarily cure it. So what’s not mentioned there is that if a disease is more manageable than curable (see in real-life: herpes) it could end that outbreak of it, while it could require a greater restoration spell to stop it from coming back later. A person could also be sick with two ailments at once (this is actually quite common, as illnesses affect the immune system), and not realise that they only cured one of them. Finally, a cleric could be at odds with the party, creating a whole other obstacle for them to have to deal with. As always, the possibilities are endless.

Laura Bailey says "Technically"
According to the Rules as Written (RAW) the above is technically correct, which is the best kind of correct.

Get down with the sickness

Hopefully I’ve given you some ideas on how to take your D&D game to sickening new depths – just remember, if your player’s don’t have strong stomachs, make sure not to get too visceral once they start turning green.

Sick anime character sleeping
Nobody avoids bedrest like adventurers, trust me

Now get out there and spread the germs love. (In-game though. Seriously, wash your hands)

Got any cool disease stories, or fun homebrewed maladies? Please do share them with us, we’d love to hear about them!

Dylan Beckbessinger

App developer by day, Chaotic Neutral dungeon master by night, Dylan has been a DM for 10 years, and an avid fan of all things geekdom for far, far longer than that. Favorite class is eldritch theurge, because raw power doesn't need any limits.


Fritzabee · April 23, 2021 at 7:13 pm

Trying to start a plague on the Sword Coast based on Robert Jordan’s Black Fever. Before I do, though… Suggestions on how players can stop a plague?

Dylan Beckbessinger · April 25, 2021 at 10:12 am

Getting a town to start isolating would help slow it down while they search for some mysterious potion/elixir/fountain of youth type solution.
A Cleric or pally can cure one person at a time with a minor or greater restoration depending on the disease.
Sometimes plagues are curses rather than diseases that need to be broken somehow, and sometimes it’s just that someone was poisoning the well and you need to stop them.
Players are a tricky lot as well, and I can guarantee they’ll ask a question that leads to a solution you didn’t think of – just listen to what they’re saying, and if it makes sense for the disease, be open to them inventing solutions you hadn’t considered

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