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On disease, the DMG says:

A simple outbreak might amount to little more than a small drain on party resources, curable by a casting of lesser restoration. A more complicated outbreak can form the basis of one or more adventures as characters search for a cure, stop the spread of the disease, and deal with the consequences.

The sample diseases in the DMG don't say they require a more complex cure than lesser restoration, though they do offer non-magical ways of curing the diseases. The diseases associated with various types of Slaadi also seem curable by that 2nd level spell.

While a DM could invent anything they choose, are there published examples of diseases that aren't immediately curable with lesser restoration or other spells? Perhaps one that, per the text, forces the characters to "search for a cure"?

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    \$\begingroup\$ Reminder to everyone that answers, including partial answers, suggestions on where to look for an answer, and frame challenges, do not belong in comments. \$\endgroup\$
    – Oblivious Sage
    Commented Aug 15, 2023 at 12:55

4 Answers 4

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Outbreaks and disease are different things

As Obie commented, you don't need a disease that is harder to break for "a more complicated outbreak", it can be the same disease that you can cure with lesser restoration.

An outbreak is the appearance of a disease in the population. If you catch it early enough, it may be simple to stop with lesser restoration. But once it has infected a large share of the population, you just do not have enough spell slots to overcome it.

For example, if the players come to a town where hundreds are infected and dozens more every day, that will overwhelm the rate of the players curative spells. At that point, the problem becomes a plot hook for finding the holy amulet that cures disease of the faithful just by touching it or whatever.

Such outbreaks are plot devices for the DM. You would not expect the DM to roll actual saving throws against infection for each citizen (p. 254, DMG):

A disease that does more than infect a few party members is primarily a plot disease.

For an interesting explanation why the local cleric did not just cure everyone before the outbreak became an issue, see here.

Uncurable diseases

For a discussion of diseases that cannot be cured with lesser restoration, see Shivers' answer, and for an example of a curse/disease as a plot device in Tomb of Annihilation, see Deep's. In addition to those there is also the Vargouille's Abyssal Curse that transforms its victims into Vargouilles and is described as a disease:

Each vargouille carries a disease that creates more of its kind; a flock of vargouilles on the wing is a plague of chaos and evil.

It requires more powerful magic to heal, at least remove curse or greater restoration.

Casting remove curse, greater restoration, or a similar spell on the target before the transformation is complete can end the curse.

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    \$\begingroup\$ Just imagined the DM's disappointed face as the players instead decide to make tiny masks, start contact tracing and break up big transmission nodes by stationing a paladin there. \$\endgroup\$
    – biziclop
    Commented Aug 15, 2023 at 11:10
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    \$\begingroup\$ Disappointed? That would be amazing! :) \$\endgroup\$
    – mkdir
    Commented Aug 15, 2023 at 14:06
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    \$\begingroup\$ Also this answer is a fair challenge, but it neglects the part of the quoted text that says "...characters search for a cure...", which to me implies that Lesser Restoration or similar isn't sufficient to cure this disease. And yes, these can be (and maybe are expected to be) plot devices, but I think this is answerable as to where, in published materials, diseases where characters must search for a cure can be found. \$\endgroup\$
    – mkdir
    Commented Aug 15, 2023 at 14:08
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    \$\begingroup\$ @mkdir: Did you read Given powerful low-level Clerical healing, how can sick, crippled or otherwise unhealthy people exist? which this answer linked? It explains why Lesser Restoration from a low level cleric isn't sufficient for a serious outbreak, so you'd still be searching for a more effective cure that could deal with more infected people per day. (If your PCs can cast Mass Heal (9th), you could gather everyone in the town into a 60ft radius of the cleric and give 1 HP of healing to each of 700 people, curing them of all diseases.) \$\endgroup\$ Commented Aug 15, 2023 at 17:14
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    \$\begingroup\$ One significant "complication" to an outbreak is when the source and/or vectors are either not obvious or not "curable" because they are either not practically catchable or not themselves technically "sick". Consider cholera: the source/vector is contaminated drinking water (and it took to the 19th century until we figured that out). Or Malaria: the vector is mosquitoes, good luck catching/curing all of them, let alone just figuring it out (18th century for us, I think). Rabid wildlife presents a similar problem. Then there's the Plague (bacteria -> fleas -> rats -> most mammals -> us). \$\endgroup\$ Commented Aug 17, 2023 at 12:34
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Yes, but not a lot.

There may be more than this, but here are a couple of examples where the disease, potentially just once it sets in, can't be cured through the use of low-level magics.

Frigid Woe requires a specific cure.

Frigid Woe from Wildemount requires a specific antidote:

The only way a creature infected with the disease can be cured is by finding and drinking the manufactured antidote, a milky liquid stored in gold vials found in Eiselcross’s ruins.

This disease has a significant plothook vibe to it that matches "search for a cure": it progresses slowly but is inevitably lethal (barring extremely high saves) without the cure.

Aboleths have a disease that gets nasty after a minute.

Aboleths inflict the following on a hit:

If the target is a creature, it must succeed on a DC 14 Constitution saving throw or become diseased. The disease has no effect for 1 minute and can be removed by any magic that cures disease. After 1 minute, the diseased creature's skin becomes translucent and slimy, the creature can't regain hit points unless it is underwater, and the disease can be removed only by heal or another disease-curing spell of 6th level or higher. [...]

While it's still curable with spells after the set-in period, it sets a fairly high bar for the caliber of magic required to deal with it. It's not necessarily out of reach for a party fighting CR10 foes, but it's definitely a more pressing issue than a run-of-the-mill disease. Given how quickly it progresses after that initial minute, it's less of an adventure plothook, though.

It's more of a plot thing, though.

Diseases in 5e don't have all that many rules to them. The section on diseases includes a couple of sample diseases, but they're basically a character-impacting stat block. After the part you quoted, the DMG says the following:

A disease that does more than infect a few party members is primarily a plot disease. The rules help describe the effects of the disease and how it can be cursed, but the specifics of how a disease works aren't bound by a common set of rules. Diseases can affect any creature, and a given illness might or might not pass from one race or kind of creature to another. A plague might affect only constructs or undead, or sweep through a halfling neighborhood but leave other races untouched. What matters is the story you want to tell.

The complication of an outbreak is with regard to the plot. If the mayor's family grows sick with cackle fever but are quarantined, that's "a simple outbreak" that the party can resolve with "little more than a small drain on party resources," as they simply need four (or whatever) lesser restos, paladins, monks, etc. If someone stumbles into the Neverwinter River, fully blinded with Sight Rot, infecting hundreds by the time the party arrives, you've got "a more complicated outbreak" on your hands. Sure, Sight Rot can be cured with a lesser resto, but if you have hundreds of cases, growing by the day, your cleric is going to be tapped before you make a dent in things.

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  • \$\begingroup\$ Great find with the Aboleth, I had forgotten about that! And thanks for pointing out how scaling the disease can make it impossible to solve with spells alone. \$\endgroup\$
    – mkdir
    Commented Aug 15, 2023 at 14:10
  • \$\begingroup\$ or another disease-curing spell of 6th level or higher - Note that this includes Mass Heal (9th) which can get up to 700 people (giving them 1 HP each) in a 60 ft radius. But IDK if it includes an upcast Lesser Restoration, for characters that don't have Heal prepared. Arguably not, since they say spell, not spell-slot, although in other cases where they want to rule out upcast lower level spells, the rules sometimes say so. It does also include Heroes Feast (6th), which gets 12 people for 1 slot, but consumes a 1000gp bowl. \$\endgroup\$ Commented Aug 15, 2023 at 21:25
  • \$\begingroup\$ I should have just linked How can a disease be removed, if the description of the disease does not specify? which includes magic items. The touch of a night hag's heartstone cures any disease, unlimited uses, so can end an outbreak in a whole village in a day going door to door, or have a parade where everyone walks by and touch it. \$\endgroup\$ Commented Aug 16, 2023 at 5:50
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Tomb of Annihilation adventure centers around an outbreak of a "Wasting Disease" called "Death Curse"

For the past several days, the talk of the streets and taverns has all been about the so-called death curse: a wasting disease afflicting everyone who's ever been raised from the dead. Victims grow thinner and weaker each day, slowly but steadily sliding toward the death they once denied.

For all intents and purposes, there is a new disease affecting people and in order to cure it, it is necessary to discover its origin, travel there and learn about what causes it and how to stop it.

As it often is in tabletop adventures the truth about the affliction in question here is more complicated than a simple disease caused by nasty bacteria.

(The spoilered section reveals endgame plot points of the adventure if the actual nature of the affliction is important to answer your question.)

The wasting disease is caused by a magical device created by the main villain of the adventure, Acererak

This affliction is essentially a plot device for the adventure, something where it is only solvable through the adventure plot and storytelling, and no common resources that the characters have at their disposal will be able to solve the problem.

While not a traditional disease, I believe that the way the adventure handles the affliction and how it describes and handles the world reacting to it are useful guidelines to what you are looking for.

It is probably useful to point out that the way the implementation of the affliction was handled in the adventure was sometimes criticized as too prohibitive and forceful, especially following effect:

Any humanoid on the planet that has been brought back from the dead begins to waste away. Its hit point maximum is reduced by 20 (1 for each day the Soulmonger has been active) and decreases by 1 every midnight until the Soulmonger is destroyed. If a humanoid's hit point maximum drops to 0, it dies. Traveling to another world or plane does nothing to halt the wasting effect once it has begun.

which essentially forced people to rush through the adventure instead of exploring it. Some ideas on how to run things differently can be found across the internet (for example here)

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  • \$\begingroup\$ +1 good find. I also looked at ToA but dismissed it as it was a "curse", but I think you make a good case for an example. \$\endgroup\$ Commented Aug 15, 2023 at 17:02
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    \$\begingroup\$ @NobodytheHobgoblin Yes, I was considering if I should add the answer or not. I think that except for the actual truth of it and the fact that it would probably require some changes if you wanted your disease to be contagious it models the whole disease outbreak adventure very nicely. It is probably best official example of how something similar could be handled. \$\endgroup\$
    – Deeps
    Commented Aug 15, 2023 at 17:45
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The Wailing Death

The wailing death was a magical disease that hit Neverwinter in 1372, and required several exotic components to cure.

The plague was actually the defense mechanism of a powerful artifact, but the man who triggered the defense was allowed to leave and spread it. The plague painfully leeched heat from the body of the victim until they died. !<

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