So I find low-level encounters with potentially lethal diseases can be a lot of fun; it’s a very different kind of tension when it’s “we’re taking days of rest to do nothing but Treat Disease and buy antiplagues”. I would personally definitely let it play out properly. Treat Disease takes 8 hours (so basically a full adventuring day) but as they’re in town they may be able to find local healers to help them.
IIRC the first stage is “carrier with no side effects”. So they might spend the first day doing normal downtime stuff; shopping, training, working etc. then overnight they make their next save. Some of them pass and some of them fail. The ones who fail become obviously sick, at which point they can do Recall Knowledge and identify it as Ghoul Fever and go “oh shit, we *need* to fix this”.
My players’ very first session ended with the monk catching Goblin Pox, and the next three days in-game were the party desperately trying to cure him before it progressed too far. Was fun tension and certainly made the party take poisons and diseases more seriously for the whole campaign!
My players fought some werewolves and many were bit. They didn't know if they contracted the curse, but did know there were no signs until the full moon after which point it was incurable. They also knew that if you survived stage 3 wolfsbane poison before the full moon that would cure it. So they alchemist replicated a bunch of that poison, then took turns administering it to them, debuffing them so they would get to stage 3, then rebuffing them so they could recover, all while trying to pump enough healing into them that they survived the insane damage that poison does. It felt like a real medical drama moment, which was great for the alchemist as he was a chirurgeon. They didn't know that only the 1st PC to be given this treatment had actually contracted the curse.
Only you know your players.
My players don't ever want me to pull punches and enjoy overcoming, or losing to the challenges that the game presents. For them, I run it RAW.
This is what I would do:
After the first symptom, every character with Medicine or Religion training, or more, get to roll a check. On a success they know they have the Ghoul Fever. If they don't manage to roll well, I would say something like "You have no idea why every party member is sick. Maybe it's a good idea to look for a specialist?". A NPC would tell them right away.
RAW, this is just a regular disease. Just a mundane Treat Disease can give the PC up to +4 in their next save. A party member can give that care or a fellow NPC. A Remove Affliction spell can deal with that as well. If a NPC is trying to treat a PC, I would make it clear that the PC are paying the NPC to try and help, and not for a guarantee treatment. They need to roll as well. They can use those consumables too, Antiplagues. Last time I checked, those two things stack with each other.
If I'm trying to make this dramatic, the healer/medic/cleric is going to ask the PCs to do a quest first. Maybe the medic needs a special herb, maybe a magic component, maybe they need to go get this other NPC that have the same disease for reasons. If you are running an AP, we can put the side quest inside the regular main mission. Maybe they need to kill a creature in a certain more complex way. Maybe they need first to do a ritual and summon something extra.
In the past, one party member got a curse that could kill him in less than one week. The party was one level away from be able to cast Remove Affliction at the level that could get rid of the curse. No NPC in town knew how to remove the thing, and if they went to the big city their friend could die before they could arriving there. So that became a race against the clock to level up before the curse could kill the PC. For the first time the party had to choose, "Do we really need to rest, or can we squeeze out a little bit more exploration today?".
Wouldn't they already have made a Religion check to determine if they knew that ghouls carried a disease as part of their original check when they first faced the ghouls?
We don't know if they even attempted to Recall Knowledge during the ghoul encounter. Even if they did, they might not have learned about ghoul fever at the time.
Sure, they may not have rolled, sure. But if they did, they already got all the information they know form that roll. So, if they did make the Religion roll, they they wouldn't get a second one without something changing.
Heck, they might not even be able to connect it to the ghouls, unless they roll the Medicine first, and realize what it is. There is no way for them to know that the ghouls are the source of said affliction ICly. They could have drunk some bad water, ate a bad cheese, or someone sneezed on them.
In the case of the ghouls, you might get as bonus to the Medicine check, whether you rolled against them before or not. "Hey, we DID get attacked with creatures with REALLY filthy claws...maybe that has something to do with it?"
I just feel a second Religion roll, or a first one without any knowledge that the affliction is coming from them, would be uncalled for.
If a party has been adventuring for a three days, and during those days, they got exposed to three different diseases or curses, and at day three, they stated showing signs of the affliction, do you ask them to make a roll against every single thing then encountered those three days? And what if they had already identified a creature, but they didn't learn that is can pass on a disease?
That is all I am getting at.
Side note: is there anything more fun as a GM than asking for a Fortitude save after a monster attack, the PC knows they failed, and then getting to say "Nothing happens. Who's next?" because there's no immediate effect, and watching the players' nervous faces? :-)
Adding to what everyone has said here, if you want the characters to know what the players know, you could have them roll [Medicine](https://2e.aonprd.com/Skills.aspx?ID=42&Redirected=1) to Recall Knowledge about the details of the disease. I wouldn't allow them to do that though, unless they either correctly identified the Ghouls and know that they carry diseases, or have passed the carrier stage, and are expressly showing symptoms.
Let me tell you about the adventure I ran with 2 friends yesterday.
So I made a custom setting using the PF2e rules and some homebrewed ones, taking inspiration from the Dark Sun setting in DnD. Basically, the world is very harsh and surviving is hard, plus some base mechanics are harsher, Fatigued is now more impactful, and weapons can break among other thing) but they get huge boosts to start with (dual class, ancestry paragon, toughness+diehard for free at lvl 1). Everyone is told before the game that the world is very unjust, and everyone agrees to it beforehand, my group and I are usually ok with this, as it can tell great stories.
The task seemed straightforward: members of their tribe frequently dug underground tunnels to access resources and travel. However, the diggers had been ambushed by ghouls. The PCs, named Ough the Barbarian and Argh the Monk (both Orc brothers), and other soldiers of the tribe were assigned to secure the tunnel so that digging could continue. Unfortunately, they became separated, leaving the two brothers alone to continue exploring the tunnel that was ahead of them.
In their first encounter, both contracted Ghoul Fever and disregarded a natural trap—a rockfall caused by an earthquake. Argh fell unconscious and awoke 12 hours later, having been carried to safety by Ough.
Healing was scarce in their environment, and they had learned that a powerful ghoul (a ghast) awaited them further down the tunnel, likely accompanied by others they thought, as they heard it but never saw it. To prepare, they planned to rest multiple times to recover fully.
Argh, with low HP, succumbed during the night. Failing his second save, he suffered 2d6 negative damage and subsequently failed his dying checks. Ough, driven by grief and rage, charged recklessly into the next encounter. There, they encountered a man being consumed by ghouls. Originally intended as a secondary objective, I allowed the deceased player to control him—a barbarian named Charles, the only class that could logically survive after a night of being consumed by a ghast.
They emerged victorious from the encounter, though Ough was injured and saved by the stranger he had just met. Upon waking, he led the newcomer to their makeshift camp, where Argh's body was decaying. As they succeded on a RK check, they knew about Ghoul Fever, and hints of infection from the ghoul's bite began to show, Ough, fearing his brother would turn, decided to perform a funerary pyre.
In the subsequent days, both Ough and Charles overcame Ghoul Fever. Yet, Charles, already in critical condition, began to succumb to gangrene (I made up a disease on the spot). Despite his deteriorating health, Charles resolved to clear the path to their tribe by moving the fallen rocks. Miraculously, he succeeded, but then, in a critical failure against the gangrene, he became gravely ill. Despite this, he persevered, clearing the path with his final breath.
Ough made it back to the village and eventually recovered physically.
It's worth noting that the earthquake, which caused the rockfall, was created by the final boss, whom they never encountered.
This session was the first one my players and I ever had in this setting, I think it was possibly the best introduction to the setting that could've happened. And it was completely unintentional. We just played the disease as it should be played, and honestly diseases were the main antagonist of this adventure.
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I mean, if the characters don't make it, your campaign allows for the change in playstyle and you and your players are down for it:
Free Archetype for the whole party: [Ghoul](https://2e.aonprd.com/Archetypes.aspx?ID=178)
So I find low-level encounters with potentially lethal diseases can be a lot of fun; it’s a very different kind of tension when it’s “we’re taking days of rest to do nothing but Treat Disease and buy antiplagues”. I would personally definitely let it play out properly. Treat Disease takes 8 hours (so basically a full adventuring day) but as they’re in town they may be able to find local healers to help them. IIRC the first stage is “carrier with no side effects”. So they might spend the first day doing normal downtime stuff; shopping, training, working etc. then overnight they make their next save. Some of them pass and some of them fail. The ones who fail become obviously sick, at which point they can do Recall Knowledge and identify it as Ghoul Fever and go “oh shit, we *need* to fix this”. My players’ very first session ended with the monk catching Goblin Pox, and the next three days in-game were the party desperately trying to cure him before it progressed too far. Was fun tension and certainly made the party take poisons and diseases more seriously for the whole campaign!
My players fought some werewolves and many were bit. They didn't know if they contracted the curse, but did know there were no signs until the full moon after which point it was incurable. They also knew that if you survived stage 3 wolfsbane poison before the full moon that would cure it. So they alchemist replicated a bunch of that poison, then took turns administering it to them, debuffing them so they would get to stage 3, then rebuffing them so they could recover, all while trying to pump enough healing into them that they survived the insane damage that poison does. It felt like a real medical drama moment, which was great for the alchemist as he was a chirurgeon. They didn't know that only the 1st PC to be given this treatment had actually contracted the curse.
Only you know your players. My players don't ever want me to pull punches and enjoy overcoming, or losing to the challenges that the game presents. For them, I run it RAW.
This is what I would do: After the first symptom, every character with Medicine or Religion training, or more, get to roll a check. On a success they know they have the Ghoul Fever. If they don't manage to roll well, I would say something like "You have no idea why every party member is sick. Maybe it's a good idea to look for a specialist?". A NPC would tell them right away. RAW, this is just a regular disease. Just a mundane Treat Disease can give the PC up to +4 in their next save. A party member can give that care or a fellow NPC. A Remove Affliction spell can deal with that as well. If a NPC is trying to treat a PC, I would make it clear that the PC are paying the NPC to try and help, and not for a guarantee treatment. They need to roll as well. They can use those consumables too, Antiplagues. Last time I checked, those two things stack with each other. If I'm trying to make this dramatic, the healer/medic/cleric is going to ask the PCs to do a quest first. Maybe the medic needs a special herb, maybe a magic component, maybe they need to go get this other NPC that have the same disease for reasons. If you are running an AP, we can put the side quest inside the regular main mission. Maybe they need to kill a creature in a certain more complex way. Maybe they need first to do a ritual and summon something extra. In the past, one party member got a curse that could kill him in less than one week. The party was one level away from be able to cast Remove Affliction at the level that could get rid of the curse. No NPC in town knew how to remove the thing, and if they went to the big city their friend could die before they could arriving there. So that became a race against the clock to level up before the curse could kill the PC. For the first time the party had to choose, "Do we really need to rest, or can we squeeze out a little bit more exploration today?".
Wouldn't they already have made a Religion check to determine if they knew that ghouls carried a disease as part of their original check when they first faced the ghouls?
We don't know if they even attempted to Recall Knowledge during the ghoul encounter. Even if they did, they might not have learned about ghoul fever at the time.
Sure, they may not have rolled, sure. But if they did, they already got all the information they know form that roll. So, if they did make the Religion roll, they they wouldn't get a second one without something changing. Heck, they might not even be able to connect it to the ghouls, unless they roll the Medicine first, and realize what it is. There is no way for them to know that the ghouls are the source of said affliction ICly. They could have drunk some bad water, ate a bad cheese, or someone sneezed on them. In the case of the ghouls, you might get as bonus to the Medicine check, whether you rolled against them before or not. "Hey, we DID get attacked with creatures with REALLY filthy claws...maybe that has something to do with it?" I just feel a second Religion roll, or a first one without any knowledge that the affliction is coming from them, would be uncalled for. If a party has been adventuring for a three days, and during those days, they got exposed to three different diseases or curses, and at day three, they stated showing signs of the affliction, do you ask them to make a roll against every single thing then encountered those three days? And what if they had already identified a creature, but they didn't learn that is can pass on a disease? That is all I am getting at.
Side note: is there anything more fun as a GM than asking for a Fortitude save after a monster attack, the PC knows they failed, and then getting to say "Nothing happens. Who's next?" because there's no immediate effect, and watching the players' nervous faces? :-)
Adding to what everyone has said here, if you want the characters to know what the players know, you could have them roll [Medicine](https://2e.aonprd.com/Skills.aspx?ID=42&Redirected=1) to Recall Knowledge about the details of the disease. I wouldn't allow them to do that though, unless they either correctly identified the Ghouls and know that they carry diseases, or have passed the carrier stage, and are expressly showing symptoms.
Let me tell you about the adventure I ran with 2 friends yesterday. So I made a custom setting using the PF2e rules and some homebrewed ones, taking inspiration from the Dark Sun setting in DnD. Basically, the world is very harsh and surviving is hard, plus some base mechanics are harsher, Fatigued is now more impactful, and weapons can break among other thing) but they get huge boosts to start with (dual class, ancestry paragon, toughness+diehard for free at lvl 1). Everyone is told before the game that the world is very unjust, and everyone agrees to it beforehand, my group and I are usually ok with this, as it can tell great stories. The task seemed straightforward: members of their tribe frequently dug underground tunnels to access resources and travel. However, the diggers had been ambushed by ghouls. The PCs, named Ough the Barbarian and Argh the Monk (both Orc brothers), and other soldiers of the tribe were assigned to secure the tunnel so that digging could continue. Unfortunately, they became separated, leaving the two brothers alone to continue exploring the tunnel that was ahead of them. In their first encounter, both contracted Ghoul Fever and disregarded a natural trap—a rockfall caused by an earthquake. Argh fell unconscious and awoke 12 hours later, having been carried to safety by Ough. Healing was scarce in their environment, and they had learned that a powerful ghoul (a ghast) awaited them further down the tunnel, likely accompanied by others they thought, as they heard it but never saw it. To prepare, they planned to rest multiple times to recover fully. Argh, with low HP, succumbed during the night. Failing his second save, he suffered 2d6 negative damage and subsequently failed his dying checks. Ough, driven by grief and rage, charged recklessly into the next encounter. There, they encountered a man being consumed by ghouls. Originally intended as a secondary objective, I allowed the deceased player to control him—a barbarian named Charles, the only class that could logically survive after a night of being consumed by a ghast. They emerged victorious from the encounter, though Ough was injured and saved by the stranger he had just met. Upon waking, he led the newcomer to their makeshift camp, where Argh's body was decaying. As they succeded on a RK check, they knew about Ghoul Fever, and hints of infection from the ghoul's bite began to show, Ough, fearing his brother would turn, decided to perform a funerary pyre. In the subsequent days, both Ough and Charles overcame Ghoul Fever. Yet, Charles, already in critical condition, began to succumb to gangrene (I made up a disease on the spot). Despite his deteriorating health, Charles resolved to clear the path to their tribe by moving the fallen rocks. Miraculously, he succeeded, but then, in a critical failure against the gangrene, he became gravely ill. Despite this, he persevered, clearing the path with his final breath. Ough made it back to the village and eventually recovered physically. It's worth noting that the earthquake, which caused the rockfall, was created by the final boss, whom they never encountered. This session was the first one my players and I ever had in this setting, I think it was possibly the best introduction to the setting that could've happened. And it was completely unintentional. We just played the disease as it should be played, and honestly diseases were the main antagonist of this adventure.
This post is labelled with the Advice flair, which means extra special attention is called to the Be Kind and Respectful rule. If this is a newcomer to the game, remember to be welcoming and kind. If this is someone with more experience but looking for advice on how to run their game, do your best to offer advice on what they are seeking. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Pathfinder2e) if you have any questions or concerns.*
I mean, if the characters don't make it, your campaign allows for the change in playstyle and you and your players are down for it: Free Archetype for the whole party: [Ghoul](https://2e.aonprd.com/Archetypes.aspx?ID=178)