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Wounded Ronin
I recently started playing Betrayal at Krondor as abandonware. It is my first time playing the game and I did not play it back in 1993. One of the many things which can happen to characters in BAK is a disease status. Typically, there are certain encounters that will inflict a disease state on the party, such as attempting to explore a house which is considered to contain a diseased individual, or certain random encounters where the enemies theoretically have pelted you with diseased materials. (I've gotten the disease status from that encounter even when the opponents did not succeed in striking any of my PCs a single time.) Since I work in a health field these events actually annoyed me tremendously because in reality there are practically speaking no diseases you're going to encounter which are that contagious. Personally, I've been in the same room as people with tuberculosis, including active TB, over a period of nearly two years and I have not been infected. A doctor I know who personally sees and evaluates each patient on the island hasn't been infected even though he's seen new and suspected cases face to face with no masks or anything for many years now. The way that diseases and illnesses are handled in role playing games is very unrealistic and for me that always hurts my suspension of disbelief.

Now I have to relate this to Shadowrun so that the mods don't poleaxe me.

This is similar to becoming infected by a ghoul in Shadowrun. I don't have my sourcebooks with me and haven't seen them for 2 years so my memory is becoming increasingly faded but as I recall the only condition which is required to infect your character is a single successful ghoul melee attack. Therefore, the treatment of infectious diseases in Shadowrun is similar to the treatment in most RPGs; that is to say, transmission is unrealistically easy.

(In reality, the probability for something like that any one time is quite low. According to the health handbook I have here, the risk of HIV transmission following a needle stick from an HIV positive positive person is only 1 in 200-500.)

I personally think that it would be more interesting if diseases were handled in a more realistic manner. It would add more dimensions to gameplay. I think it's analagous to making the firearms rules more realistic and less cinematic. If we're talking about diseases, it's no longer about "nyah nyah nyah, the bum stabbing me with the HIV infected needle didn't get any successes on his attack roll but had he got a single success I'd automatically be infected", but rather about a broader range of sanitation and health issues with more complex planning attached to it.

What are some of the issues we would end up looking at instead? Well, fundamentally, maintaining good health is about managing probabilities of risk. We exercise and eat healthy because it reduces (but does not eliminate) the probability of death by heart disease. We can choose to ignore hygiene and not treat open cuts either in the interests of expediency or for in-character reasons but this would increase the probability of getting a staph infection which in turn increases the probability that beyond swelling and pain at the site of infection we might possibly be incapacitated with an infection-related fever. We can dive into the sewage to hide from the Renraku Red Samurai and it might be the best course of action at the time but if we've later got to deal with the possibility of hepatitis, leptospirosis, etc. We should weigh the probability of being killed by the RRS versus the risk of our stats being badly erroded by these various diseases later.

Sanitation, in my mind, provides a lot of interesting material for any military or mercenary themed game. The military has certain procedures to ensure field sanitation and this is because it's a well established fact that armies can and have been weakened or disabled due to disease. How do the PCs ensure adequate levels of sanitation in the field? I think this adds depths to gameplay or if nothing else in-character thinking.

Exposure to diseases becomes more nuanced. It shouldn't be, "oh no, you were stabbed with the needle, now you're screwed." I think it's much more nerve-wracking and interesting if you don't really know if you're infected or not. That's where the probabilities come in. Imagine if you somehow did end up getting stabbed with a HIV infected needle. You know your odds are pretty good of not being infected (see above) but depending on your personality the possibility that you *could* be infected, and that you couldn't find out for a while since you'd need to wait for the "window period" to elapse before getting your HIV test could really kill you.

I just think that the real world has a lot more to offer in terms of complexity and interestingness if we look at real medical information regarding disease and sanitation in our RPGs than if we fall back on the tired and cliched Hollywood paradigm of instant infection upon the slightest exposure.
Link
A quick read of SR3 disease rules reveals that VITAS 3 is very contagious and not much else. Same goes for HMHVV spread by pestilence though this is a metavirus.
Shadowtech has the general immunity gene therapy and this is a good way to separate the SR haves from the have nots - expensive treatments protect the rich while anti-biotic-resistant-super-bugs decimate the poor and weak.

Relevant rules from SR3 & Critters.
PESTILENCE
[ Spoiler ]

DISEASES AND TOXINS
[ Spoiler ]
Talia Invierno
Transmission of contagious diseases new and old is so wide a topic, entire degrees and careers are devoted to it. So let's try to summarise the core points into a few brief house rules grinbig.gif

Divide out first type of contact (how it enters the body) from vector (what it uses to transmit). The types of contact already have an SR equivalent: in the pharmaceutical section. The four types described there (inhalation, injection, ingestion, skin contact) work well enough as a sweeping summary. That's not where the opening post concern lay.

IIRC the major vectors for contagious disease transmission were airborne (eg. flu, tuberculosis), bodies of water (eg. cholera), food (eg. salmonella poisoning), parasitic (eg. bubonic plague), and direct contact with body fluids (eg. Ebola). Several diseases can be transmitted through more than one of these vectors, although the secondary vector is rarely as efficient. For example, some water- or fluid-transmitted diseases, such as rabies, have been documented (rarely) to be transmitted through the air. (The incidence I remember involved masses of bats and no possibility of biting or other direct salivic transmission.) Although airborne is cinema-classically most feared, I'd be more concerned about something viral firmly lodged in the local water supply: not removable through most conventional water purification techniques, and almost impossible to filtre out. Even bacterial infection through water can be very difficult to eradicate: remember the S.American cholera epidemic of about ten years ago? which even reached the United States?

How likely it is to catch a given disease does not depend primarily on vector, except insofar as a given person is exposed to disease carried by that vector, and can't catch any disease for which no vector exists. As Wounded Ronin points out, HIV is (fortunately) not all that transmissible either from needlestick or even sexual contact, but others (herpes, hepatitis) can run as high or higher than 1 in 3: which is why needlestick injuries are treated so seriously in hospital environments. (Where resources are available, a reported needlestick incident is followed by a month-long regimen of aggressive pre-emptive antivirals and antibiotics, the side-effects of which can approximate chemotherapy.) There are many, many diseases out there!

However, transmission of the infection is not quite the same as catching the infection; and afterwards, after the disease is caught, catching it is not the same thing as ever developing symptoms. Our primary defence against disease of all kinds is our own immune system -- which is one reason why tuberculosis has become such a concern in the post-AIDS world: AIDS and tuberculosis are often found together. Concern to the non-AIDS-infected general public is that the greater the pool of those infected, the more likely the disease is to spread outside the original disease pool, or even to mutate into more difficult-to-treat forms. Recent news stories may have also reminded that it is entirely possible to be a carrier without showing any active symptoms: either by actually having an extremely mild form of the disease (easily mistaken for something different), or by having been exposed previously without ever becoming symptomatic.

Personal environmental factors ultimately determine whether an exposed person will develop a fully-symptomatic disease. All other conditions being equal, an otherwise healthy doctor with a healthy immune system, living in relatively hygienic conditions and with a regular, wholesome diet, is far less likely to catch any disease than (for example) a malnourished, displaced refugee living in overcrowded conditions. Tuberculosis spreads rapidly among the poor specifically for these reasons, while leaving most medical personnel (relatively, considering the frequency of exposure) untouched. In fact, overcrowded conditions with minimal ventilation for significant periods of time is a prime breeding ground for tuberculosis: one reason airline flights have become such a concern. A skin test can quickly identify the true degree of exposure: most medical personnel working extensively with tubercular patients test positive, even though they themselves don't have either disease symptoms or are themselves carriers.

Other factors could invert the pattern quickly. The local population could have built up an immunity to local pathogens which newcomers would be much more vulnerable to: witness the experience of explorers in Africa and parts of Asia (or, more familiarly, the tourist injunction against drinking the local water). Alternately, the local population might have no resistance to infections with which the newcomers have lived for generations: the epidemics which swept through native N.American tribes after European contact are particularly well-documented.

And of course, stress always increases one's chances of catching anything: both through direct hormonal effects, and indirectly through harm caused to various physiological systems which would otherwise work much better to resist disease.

(I don't venture into antibiotic resistant. That is treatment, and we are referring to catching.)

Returning to Shadowrun, the likelihood of catching and becoming symptomatic with a given disease is a BD test (independent of damage-resistance mods), TN or number of hits required determined by the disease's power, which again works well enough as an isolated mechanic, even for Pestilence powers.

What might be needed though is (1) modifiers based on the vector, and (2) modifiers based on the potential victim's personal environment. It should be very easy to house-rule a few of these modifiers -- in fact, a few can be lifted from the surgery section of M&M directly. A few possible modifiers (to TN or number of dice, choose your poison):

+1 TN / -1 die if the PC has been in a hospital in the last 48 hours
+1 TN / -1 die if a 3+hour public flight has been taken in the last 48 hours
+ [days] TN / - [days] TN for lack of sleep (less than 6 hours a night, halved for sleep regulators). This modifier stays in place and can keep growing until a solid 8-hour sleep.
+2 TN / -2 dice for direct contact with infected food or water
+2 TN / -2 dice for direct contact with sewage contamination
+2 TN / -2 dice for significant exposure to radioactives (ie. exceeding government-permissible daily limits)
+3 TN / -3 dice for direct contact with infected body fluids

- 3 TN / + 3 dice if treating with an appropriate prophylactic for at least the last 24 hours (ie. anti-malarial medication)
- 4 TN / +4 dice if life has been good, the past week (stable, good food, clean air, adequate sleep, regular and reliable sanitation) -- but only -1 TN / +1 die if only one or two of these factors apply

Either a bonus or a penalty (GM's decision):

+/- 2 TN / dice for not being local to the area.
+/- 3 TN / dice for not being born in the area and remaining local to it (adding in the genetic factor).

(Obviously these last two would not apply to most Pestilence-type diseases.)

If the roll ends up being exactly a tie to what is needed, the PC develops no symptoms, but might become a carrier (GM's discretion). Additionally, if personal conditions significantly worsen, the latent disease might again become active: another roll required, but no additional penalties or bonuses. (Think cold sores.) I figure the body's having been primed to produce appropriate antibodies balances out the automatic infection. This could be something really evil to turn on the player who thinks their PC has escaped HMHVV infection ...

More could easily be added. These were just off the top of my head.
sunnyside
I think you'd also have to houserule some diseases. I from the fluff VITAS and HMHVV are "magic" diseases almost as closely related to a powerbolt as to a cold virus. Which is why modern medicine has such a hard time with them.

But if you're into that sort of thing regular diseases might be interesting to have. Shadowrunners have a habit of running through sewers with deep open puncture wounds, so the possibilities are there.
X-Kalibur
Remember that pile of hypodermics you waded through? Surprise! You have Herpes Simplex 2!
Wounded Ronin
QUOTE (Talia Invierno)
Transmission of contagious diseases new and old is so wide a topic, entire degrees and careers are devoted to it. So let's try to summarise the core points into a few brief house rules grinbig.gif

Divide out first type of contact (how it enters the body) from vector (what it uses to transmit). The types of contact already have an SR equivalent: in the pharmaceutical section. The four types described there (inhalation, injection, ingestion, skin contact) work well enough as a sweeping summary. That's not where the opening post concern lay.

IIRC the major vectors for contagious disease transmission were airborne (eg. flu, tuberculosis), bodies of water (eg. cholera), food (eg. salmonella poisoning), parasitic (eg. bubonic plague), and direct contact with body fluids (eg. Ebola). Several diseases can be transmitted through more than one of these vectors, although the secondary vector is rarely as efficient. For example, some water- or fluid-transmitted diseases, such as rabies, have been documented (rarely) to be transmitted through the air. (The incidence I remember involved masses of bats and no possibility of biting or other direct salivic transmission.) Although airborne is cinema-classically most feared, I'd be more concerned about something viral firmly lodged in the local water supply: not removable through most conventional water purification techniques, and almost impossible to filtre out. Even bacterial infection through water can be very difficult to eradicate: remember the S.American cholera epidemic of about ten years ago? which even reached the United States?

How likely it is to catch a given disease does not depend primarily on vector, except insofar as a given person is exposed to disease carried by that vector, and can't catch any disease for which no vector exists. As Wounded Ronin points out, HIV is (fortunately) not all that transmissible either from needlestick or even sexual contact, but others (herpes, hepatitis) can run as high or higher than 1 in 3: which is why needlestick injuries are treated so seriously in hospital environments. (Where resources are available, a reported needlestick incident is followed by a month-long regimen of aggressive pre-emptive antivirals and antibiotics, the side-effects of which can approximate chemotherapy.) There are many, many diseases out there!

However, transmission of the infection is not quite the same as catching the infection; and afterwards, after the disease is caught, catching it is not the same thing as ever developing symptoms. Our primary defence against disease of all kinds is our own immune system -- which is one reason why tuberculosis has become such a concern in the post-AIDS world: AIDS and tuberculosis are often found together. Concern to the non-AIDS-infected general public is that the greater the pool of those infected, the more likely the disease is to spread outside the original disease pool, or even to mutate into more difficult-to-treat forms. Recent news stories may have also reminded that it is entirely possible to be a carrier without showing any active symptoms: either by actually having an extremely mild form of the disease (easily mistaken for something different), or by having been exposed previously without ever becoming symptomatic.

Personal environmental factors ultimately determine whether an exposed person will develop a fully-symptomatic disease. All other conditions being equal, an otherwise healthy doctor with a healthy immune system, living in relatively hygienic conditions and with a regular, wholesome diet, is far less likely to catch any disease than (for example) a malnourished, displaced refugee living in overcrowded conditions. Tuberculosis spreads rapidly among the poor specifically for these reasons, while leaving most medical personnel (relatively, considering the frequency of exposure) untouched. In fact, overcrowded conditions with minimal ventilation for significant periods of time is a prime breeding ground for tuberculosis: one reason airline flights have become such a concern. A skin test can quickly identify the true degree of exposure: most medical personnel working extensively with tubercular patients test positive, even though they themselves don't have either disease symptoms or are themselves carriers.

Other factors could invert the pattern quickly. The local population could have built up an immunity to local pathogens which newcomers would be much more vulnerable to: witness the experience of explorers in Africa and parts of Asia (or, more familiarly, the tourist injunction against drinking the local water). Alternately, the local population might have no resistance to infections with which the newcomers have lived for generations: the epidemics which swept through native N.American tribes after European contact are particularly well-documented.

And of course, stress always increases one's chances of catching anything: both through direct hormonal effects, and indirectly through harm caused to various physiological systems which would otherwise work much better to resist disease.

(I don't venture into antibiotic resistant. That is treatment, and we are referring to catching.)

Returning to Shadowrun, the likelihood of catching and becoming symptomatic with a given disease is a BD test (independent of damage-resistance mods), TN or number of hits required determined by the disease's power, which again works well enough as an isolated mechanic, even for Pestilence powers.

What might be needed though is (1) modifiers based on the vector, and (2) modifiers based on the potential victim's personal environment. It should be very easy to house-rule a few of these modifiers -- in fact, a few can be lifted from the surgery section of M&M directly. A few possible modifiers (to TN or number of dice, choose your poison):

+1 TN / -1 die if the PC has been in a hospital in the last 48 hours
+1 TN / -1 die if a 3+hour public flight has been taken in the last 48 hours
+ [days] TN / - [days] TN for lack of sleep (less than 6 hours a night, halved for sleep regulators). This modifier stays in place and can keep growing until a solid 8-hour sleep.
+2 TN / -2 dice for direct contact with infected food or water
+2 TN / -2 dice for direct contact with sewage contamination
+2 TN / -2 dice for significant exposure to radioactives (ie. exceeding government-permissible daily limits)
+3 TN / -3 dice for direct contact with infected body fluids

- 3 TN / + 3 dice if treating with an appropriate prophylactic for at least the last 24 hours (ie. anti-malarial medication)
- 4 TN / +4 dice if life has been good, the past week (stable, good food, clean air, adequate sleep, regular and reliable sanitation) -- but only -1 TN / +1 die if only one or two of these factors apply

Either a bonus or a penalty (GM's decision):

+/- 2 TN / dice for not being local to the area.
+/- 3 TN / dice for not being born in the area and remaining local to it (adding in the genetic factor).

(Obviously these last two would not apply to most Pestilence-type diseases.)

If the roll ends up being exactly a tie to what is needed, the PC develops no symptoms, but might become a carrier (GM's discretion). Additionally, if personal conditions significantly worsen, the latent disease might again become active: another roll required, but no additional penalties or bonuses. (Think cold sores.) I figure the body's having been primed to produce appropriate antibodies balances out the automatic infection. This could be something really evil to turn on the player who thinks their PC has escaped HMHVV infection ...

More could easily be added. These were just off the top of my head.

Preach, brotha! Preach!
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