Quite some time ago, I worked on "Tech Infrastructure" posts for Psi-Wars, small things like how electricity worked or how computers worked. Most of it was in preparation for my stint in GURPS Vehicles. One of the things that I wanted to work on, but never got around to, was medicine, and awhile back one of my Secret Council urged me to finish that up. With my work on Xen brought to the forefront by a Bounty Hunter poll, I started work on that. And then I ran into a problem.
Disease.
See, Psi-Wars sets at the nexus between sci-fi and fantasy. On the one hand, it's the sort of setting where you expect to go into a med-lab, get bio-scanned and then sit in a regeneration chamber for an hour. On the other hand, it's also the sort of setting where you might expect an attractive alien witch-doctor to tend to your wounds with an herbal poultice and by casting the demons out of you. This meant I needed to explore both how Bio-Tech handles disease, and how the Heal advantage handles disease, whereupon I learned that they handle it in the roughest way possible: there's some penalty and some cost based on very vague guidelines (1 fatigue for "the sniffles" while -15 for "bone marrow cancer."). In fact, in general, I found all the guidelines on disease to be wildly vague. You can find about 5 or so defined diseases, and all the rest are left "up to the GM."
This isn't the first time I've wrestled with disease. I had a backer who commissioned a treatise on disease, which ended up as a backer bonus for those who want a disease system. But as I worked on handling disease in Psi-Wars, I noticed something:
Nobody Takes Resist Disease
I asked a friend of mine what I'm going to ask you, dear reader: have you, or anyone you known, taken Resist Disease in an RPG? If so, did they ever see any use out of it?
See, I like playing with disease and poison in RPGs, since it represents an unusual "attack vector" that not a lot of people defend against. I remember hitting some Exalted characters with a poison-based NPC, and how they panicked and bought Poison Resistance shortly after. But I often find that most people don't bother with Disease or Poison Resistance because the GM doesn't bring it up. After all, taking resistances is usually about anticipating what the GM will do: they're "passive" abilities, mostly, rather than active abilities (though, as with many "passive" abilities, you can be more active in making use of them; like if you are immune to disease, you can chuck around viral bombs if you want).
So, why don't GMs include disease more often? I think there's a few reasons for this.
First, the disease rules are complicated. You have to roll to see if you got it. Then you have to roll to see if you got over it. Each disease has its own modifiers for this. Then you have to roll for damage. Then, if you take enough damage (but only from the disease, not from, like, bullets and such) then you get a symptom. There might be several such symptoms. Your characters HP slowly drains away until they die, or until they recover. It's a lot of work to know the details, and there's not much in the way of general guidelines.
Second, I think most people don't see diseases as having a place in the more dramatic games that tend to be more popular. Sure, if you're running After the End or some realistic medieval fantasy game, either with time management, then you might concern yourself with the specifics of disease rules, especially because making decisions like spending a few more days out in the boonies while Joe is slowly wasting away or giving up some phat loot to rush him to a hospital is a pretty valid choice in a game that tracks time and supplies. But in a Monster Hunter game, or Dungeon Fantasy, or Action, where we might handwave travel time and concern ourselves only with the moments bullets are flying, what purpose does disease serve?
Consider: you're in an action game in the Jungle and you drink something you shouldn't and fail your HT roll for Cholera. So? What happens? If some guys attack immediately, your cholera is irrelevant. You didn't take any damage, you don't have any symptoms. You can go and defeat them, track them back to their lair, defeat a giant, gun-toting gorilla, rescue the girl, and leave to fly home, and, the next day, fail an HT roll to lose some fatigue and get the runs. If the game involves slogging through the jungle some more, we have to stop, figure out exactly how many days, and roll that many times, to see how much damage you took and whether you have symptoms or not.
It's not sexy, it's not fun, it's fiddly, and by not taking Resist Disease, you're playing chicken with the GM: you have a "vulnerability," but to exploit it, the GM needs to go through highly specific steps to make it relevant that probably aren't worth the hassle.
The one exception is the zombie plague, which often comes up. There is a single, spectacularly dangerous plague sweeping through the world, and a great deal of gameplay revolves around not getting the disease. You might wear NBC suits and if you get shot, roll against your NBC suit skill to see if you were exposed to the plague and if you were, roll HT to see if you caught it, and if you did, the rush is on to find a cure before you survive. But this runs into a different problem in that there is one disease you must resist. Immunity (Single Disease) is a perk. Players can "opt out" of such a scenario with ridiculous ease. In fact, the whole point of Immunity (Single Disease) as a perk is the implication that there are other diseases to contend with. That you live in a world with cholera and influenza and zombie plague. Thus, while this sort of scenario helps, it doesn't actually fix the problem.
Dr. Kromm, Head of Epidemiology
As usual, Dr. Kromm to the rescue. In GURPS Action 2 under the section on WMDs, he suggests that those exposed to such a disease should lose all their HP but 1, have a -5 to all DX and IQ rolls, and generally be lethargic and miserable until they find a cure. In GURPS DF 16: Wilderness Adventures, he introduces "Swamp Fever" which applies a flat -2 to your rolls until you recover from it. In these cases, the disease becomes binary: you have it or you don't, and it affects your performance or it doesn't. It won't kill you, because that doesn't suit these genres (if you're going to die, let it be by beam or bullet, not microbe), but it's still a pain in the butt. In this scenario, if our jungle soldier drinks some water he shouldn't and gets Jungle Fever, he's immediately at -2 to the rolls to fight the bad guys, their gorilla, and rescue the girl, and that sucks! Now, he actually cares about his disease resistance. When someone plays as a medic, that medic's skill with Hazardous Materials and Pharmacy (Synthetic) becomes vastly more useful.
Kromm also gave us something else highly useful: the Ham Clause. This allows us to abstract our disadvantages into a single, one-scene penalty. Instead of rolling to see if you get angry at people, the GM can declare that you're at -2 for a scene "because you're so damn angry!" Well, we can apply the same logic to disease, can't we? You have a generic penalty, and once a session, for a scene, the GM can make it more intense: you have Jungle Fever (-2 to DX and IQ), but once a session you get "cramps" which up that to -4 for a scene or a fight. We could even trade it out for Afflictions: instead of increasing it to -2, you get "Severe Pain," which also means that if you have High Pain Threshold, you can shrug it off, for the most part.
We can even abstract away the damage people take from these diseases: in practice, characters will take X amount of damage (to fatigue or HP) and cannot heal that damage until they recover from the disease. We could treat that as a flat, one-time penalty. This isn't realistic. You'd slowly accumulate that damage over time, but the GM can handwave that as much as he handwaves the rest: you're sick or you're not, and the symptoms we outline here would be when your sickness is full blown. If you literally just drank the tainted water, the GM might describe you feeling a bit ill, but not hit you with the symptoms yet, and then slowly introducing them over the next scene, until by the end of the session you have a full-blown case. But that's only if he wants. It becomes a story telling consideration. Similarly, we 'd expect these diseases to actually kill people, but the point here is that they won't kill the PCs. But they can still be inconvenienced!
If we take this approach, disease becomes something we can easily handle: some generic penalties to a few particular traits, and a once-a-session dramatic penalty, perhaps a momentary affliction. They have a disease or they don't, and it's easy to improvise it on the fly to suit a more narrativistic approach to GURPS, rather than a time-telling version.
It's also wrong, I think, to assume these have no place in a dramatic story. The character fighting in the jungle faces more than just Jungle Fever: there could be an Ebola outbreak, on the more severe end, and he could get the sniffles, on the less severe end. "The sniffles" might sound silly, but I've seen plenty of stories (typically more comical stories) where the hero begins to sneeze throughout the adventure, much to his chargin, or has a very distracting itch. These are minor issues that a mere mortal must deal with that more resistant characters, like demi-gods, vampires and robots, never need to bother with. And I think they deserve a place, and we can easily handle them with no penalty and a minor, once a session scene with a mild affliction (sneezing or itching). And now, we also have a variety of diseases that makes having Resist Disease more worthwhile.
The Scale of the Problem
With these ingredients, all we have left is to discuss the scale of our diseases.
Trivial Diseases
These are truly minor diseases, more embarrassing inconvenience than real problem. If you got one, you might call in sick to work, but your boss would frown and mutter if you did. You must roll HT+1 to avoid getting one, and you can roll HT+1 daily to recover, and you will naturally recover after a week. A visit to the doctor will generally do nothing (They'll just give you some pain medication and tell you to let it run its course). It has no penalties (at most, a -1 reaction modifier because you sound funny or you've got snot dripping out over your face), and it has only a mild Affliction (worth less than +50% on the Affliction advantage), typically Coughing, Sneezing, Itching, Drowsy, Tipsy or Mild Pain as a "dramatic penalty" once a session. Very few people ever die of these: on a critical failure, maybe an NPC gets a worse disease (that is, the cold didn't kill you, the pneumonia that came after did).
Example: a Cold
The GM might rule that you can be immune to all Trivial Diseases with a single perk, or that someone with any level of Resist Disease is immune to all Trivial Diseases.
Healing these with the Healing advantage costs 1 fatigue and has no penalty.
Minor Disease
These are genuine threats to the character, but most people will recover from them. You roll at HT-2 to avoid them and HT-2 daily to recover from them. The GM might put an upper limit on the duration (between a week and a month). The penalties can be anything from a constant minor affliction to -1 to -2 to any Attribute, and up to 1d one-time damage to HP or FP that cannot be healed until the character recovers. The Dramatic penalty can be any irritating affliction.
Example: Swamp Fever; we might give is Severe Pain as a dramatic penalty.
Healing these with the Healing advantage generally requires a -4 roll and costs 8 fatigue.
Major Disease
This is what people think of when they talk about "disease." These will kill you if you're not a PC, and you'll likely end up in the hospital for a good long time if you get it. You roll at HT-4 to avoid them and HT-4 daily to recover from them. The GM might still put an upper limit on the duration, but that's generally because if you're not over it in a week or a month or so, you're realistically dead. The penalties can be anything any irritating affliction, up to -4 on attributes, and up to 2d one-time damage to HP or FP that cannot be recovered, and your dramatic penalty is any Irritating or Incapacitating (but not Mortal) Affliction
Example: We might say Ebola requires an HT-4 to avoid if you touch the blood of the infected, and it might give you a -2 to HT, -2d HP, and Hemophelia for the duration of the disease, and we might add Seizures (for 1d minutes) as a dramatic penalty.
Healing these with the Healing advantage generally requires a -8 roll and costs 16 fatigue.
Greater Diseases
These are your WMD-level diseases. Resisting them is generally HT-6, and they reduce the character to 1 HP and FP, which cannot be recovered, and the character is at -5 to all DX and IQ rolls. The GM might allow any Irritating or Incapacitating Affliction as a dramatic penalty. The character might not be able to recover at all without some outside assistance!
Healing these with the Healing advantage generally requires a near miraculous roll with a -12 penalty and a cost of 24 fatigue.
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