The residents of Orléans have been hit hard; the plague has overtaken them and brings suffering and misery to the population. Many have died, and even the plague doctor can only bring limited relief and hope to the long-suffering residents. The church also has little to offer when it comes to lighting. And so in the end everyone is on their own and everyone must try to protect their followers as best as possible...

Right at the start of the game, conditions are made more difficult by the "rat cards". Sometimes there are fewer monks in the game, sometimes no cogs can be placed on place cards or the construction of trading stations must be paid for with an extra coin.

New events are now also linked to the "corpse tokens", a certain number of which players must place in their pocket at the end of each round. These are then randomly drawn from the bag at the start of the round and take up valuable space on the marketplace as they cannot be used for actions. To get rid of it for good, a player can fulfill indulgence cards through pilgrimage, donations, or other conditions, which also grant victory points at the end of the game. Fortunately, each player has a "plague doctor", a new figure that is available (almost) every round and can be used universally.