The Mortality Rate of the Common Cold

I’m getting over a cold unlike one I’ve ever had; I lost my voice and had to stay home from work for almost a week as to not Patient Zero my office. This got me thinking about how sickness and disease is treated in Pathfinder. Today, on Code/Switch were talkin’ ill about illness.

Disease in Pathfinder

There are two rule-sets published by Paizo for disease; one in the Core Rulebook and one in Pathfinder Unchained. The Core Rulebook rules for disease are pretty simple; the disease is contracted, an onset period elapses before symptoms manifest, and saves are rolled to avoid harm from the disease and hopefully end it. Most diseases do a type of ability damage or drain, but only those that do constitution damage or drain can kill a character.


Paper has a racial constitution penalty to being with.

There’s something inherently unsatisfying with these rules. In torturing my Skulls and Shackles group with the disease Filth Fever, it wouldn’t do enough damage to out-heal what they gained with overnight care. I understand in a world with magic disease can be less of an issue, but also there’s something to be desired in regards to a diseases actual symptoms. When you’re sick you feel gross and weak, but you also have negative effects besides just statistical penalties. You sweat, vomit, lose your voice, poop, bleed, gain aversions to perceived contributing factors, the list goes on forever.


You’re going to need to find one of these fast.

The Pathfinder Unchained rules acknowledge this fact and change how diseases work. You still contract the disease and have it manifest over time, but instead of just doing a damage, you advance down a “debilitation track” based on if the disease affects your mind (like rabies) or body. When you fail saves to combat the disease you gain penalties, and after enough failed saves the disease kills you, unlike non-constitution based diseases using the Core Rulebook rules. The Pathfinder Unchained disease rules go further by creating a mechanism for latent disease characters and less severe diseases. For example you could use those rules to replicate my cold; fail a save have it manifest, fail again make me weakened, fail again have me lose my voice, and then just end the disease track there. Heck Pathfinder even has a spell that emulates the effects of losing your voice to torture your spellcasting PCs with, Silence!


No more creating demiplanes for you, Nex.

Great (Disgusting) Creative Power

Using the Pathfinder Unchained rules for disease you can feel free to use more diseases at your players without risking killing them with a cold or boring them to death. They’re also better at making specific real world illnesses. I used my cold above as an example, but the original disease rules lump most diseases into giant meta-categories under the banner of one disease. Filth Fever for example seems like a disease-golem of cholera, typhoid, malaria, and yellow fever. I can’t implore Pathfinder players and GM’s enough, go check out Pathfinder Unchained, it has a lot of really dope alternate rules that aren’t Pathfinder Society Legal, but would fit well in a home game.

Have any cool disease stories from your game sessions or any afflictions you wanna model using the Unchained Progression? Give a holler in the comment section below.

James Ballod

James blossomed into geekdom like a piranha plant in the crack of a sidewalk. Watered by the muscle-brained lore of Warhammer 40,000 and nurtured in the rough bosom of World of Warcraft, tabletop RPGs came late in life to James. The rich lore and real-world influences in games like Pathfinder inspire James to explore them from every angle. When not being an annoying anime-fanboy he can be found discussing the history of various cuisines and over-analyzing real world influences in works of fiction.