Meta-Illness and Extra-Diegetic Disease in RPGs

This is a tangent on my meta-narcotics post and only really half, or the start of, a mad, little idea. Sickness, illness - having your character contract and deal with a disease in a game is rarely very exciting from a mechanical or roleplay perspective. It could be... much goofier. Having your character take one-off or cumulative stat damage is dull and forgettable, we could make it more engaging and present in everyday play - we could make it META. So;

A disease is made of three different components; a symptom, one or more triggers and an effect. I will show this with the following example: 

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Oh no! The adventurer, Gorto Gold-Groveler, has contracted Dungeon Lung! Now Gorto's player (not Gorto the character) must pretend to wheeze before they try to speak to an NPC. Each time Gorto's player does not wheeze or forgets to do so, Gorto will lose 1 HP permanently until his sickness is cured. When cured, Gorto will regain any lost HP. If uncured, Dungeon Lung becomes progressively worse and soon Gorto's player will have to pretend to wheeze whenever they make an ability check. The Dungeon Lung may even progress to a final stage, where the player must wheeze if they are making Gorto do anything other than lay prone. If another player tries to remind Gorto's player to wheeze whenever there is a trigger, that player has opened themselves to risk of contagion and must make a save against becoming infected with Dungeon Lung themselves. 

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Does that make sense? While the symptom, trigger(s) and effect can be remixed and swapped out entirely, the core of the idea is - the illness's symptom must be performed the afflicted player whenever a trigger is encountered during play, if not, the afflicted character suffers from the disease's effect. This way, disease becomes more interactive and present for the afflicted player and the rest of the table. With this method, a disease has no other effects than when those caused by a trigger - either the player acting out the illness's symptom or forgetting to do so and suffering an effect. For me, it simply simulates the experiences and feel of actually being unwell - and it is funny and a little gross. Be weird, try it.

Symptoms:

Choose symptoms that can be easily acted out by your players. Below are the obvious symptoms for representing mundane illnesses. A lot can be gained from slightly tweaking these symptoms to make them more fantastic but keeping them relatable and recognizable as something that could be considered a disease - glowing snot, retching up live frogs, scratching at fresh squamous, tentacular growths. 

• Cough
• Sneeze
• Wheeze
• Groan
• Scratch and itch
• Have the player draw three spots/a rash/worms on their skin with a marker. 
• Pretend to vomit
• Clear their throat
• Pretend to blow their nose
• Say "ow!" loudly
• Overtop blinking or eye-rubbing
• Put their head on the table with their eyes closed for 10 seconds.

Triggers

Any common event, behaviour or action that can occurs frequently (in or out of character) during a session makes for a good trigger. Late stages of disease should have inverted triggers, triggers that happen when the player is NOT doing something. Here are some initial examples for the beginning of a disease: 

• When the sick character makes a attack.
• When the sick character is attacked.
• When initiative is rolled for.
• When casting spells (for Magic-User only illnesses).
• When making an ability or skill check.
• When asking the DM a question.
• When speaking to another player. 
• When rolling for encounters.
• On saying something to an NPC.
• Whenever the sick character runs.
• Whenever you have to write or change something on your character sheet.
• When rolling any die. 
• When trying to be sneaky - if you neglect your symptom you might splutter, cough and break your stealth. 

Effects

The mechanical effect of an illness can be anything you like, from stat or hitpoint damage to mutations or things stranger or more magical. These effects should be permanent until the disease is cured, at which point they will disappear (or not if you are cruel or the disease is meant to be terrifying - I wouldn't recommend this without telling your players first). Remember that a disease's effect is neither directly caused or prevented by the trigger or the symptom and that the meta-illness method is an abstraction rather than a simulation. Optionally, a player cannot level up when afflicted by a disease.

Disease Progression and Cures

Players can cure their characters (and in many ways themselves) normally in-game with potions, spells, magic items, abilities or questing for a cure. Otherwise, at anytime after their first full session of having the illness, the player can elect to see if they feel better via a modified Save vs Poison roll. This roll is modified by the player's choices/condition/situation and can be made during downtime or in the middle of an adventure. If done immediately, take the character's previous 24 hours into account when applying the modifiers. The modifiers are as follows:

• Per full day/week of bed rest (depending on the severity of the disease being represented) +1 
• Per 2 days/week of uninterrupted non-bed rest +1 
• Double the bonus of rest if tended to by a physician for same amount of time
• Weak or Strong medicine taken +2 or +4
• Good, suitable diet +1

- Apply negative modifiers if any of the following are true:  

• Poor or extremely poor conditions (such as in a dungeon) -2 or -4
• The afflicted character is at less than half HP -1
• Poor or minimal diet i.e. rations -1
• Disgusting diet -2

If the player fails this roll then the disease will worsen and more triggers will come into effect. The third stage of a disease should be the most debilitating - you could even have a fourth stage which results in death (I don't think I would). While this is not necessarily a realistic simulation, combining it with convalescence does streamline and quicken the process and prevents the illness from intruding even more into the game and detracting from playtime or taking up the DM's headspace. 

Contagion

Spreading a disease works in a similar meta way, if a player reminds the afflicted of their trigger/symptoms they themselves must Save vs Poison to see if they become infected by the contagion. However, the DM is free to call for any player to make a save against infection at any time the DM deems it appropriate. For example; sharing potions, wrestling.