When you use the Orléans: Die Pest / The Plague expansion, the game conditions are made tougher from the start of play thanks to the "rat cards". Sometimes there are fewer monks in the game, sometimes no gears may be placed on place cards or the building of trading stations must be paid for with an additional coin.

New events are now also linked to the "corpse tokens" which players must place a certain number of in their bag at the end of each round. These tokens might be randomly drawn from the bag at the beginning of the round and occupy valuable space on the marketplace because they cannot be used for any action. To get rid of them for good, a player can fulfill indulgence cards through pilgrimage, donations, or other conditions, which also bring victory points at game's end. Fortunately, each player has a "plague doctor", a new figure that is available in (almost) every round and can be used universally.