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Its there alright Ive seen it! And yes it mostly just kills off the background population while you and your courtiers should be fine. The economy just takes a set back,
In history, it had a gigantic impact on both Christian and Islamic worlds. In Middle East, it contributed to the general downfall of the great muslim civilization (that has already began due to Mongol invasions). In Europe, it killed somewhere like 1/3 of population (with some countries struck harder, like the merchant republics, France). As anyone can imagine, such rapid depopulation cannot go unnoticed in economy, social balance etc. It hit hard trade for a few years, agricultural output as well (though it was balanced by the death toll).
Above else, it changed the feudal structure, as there were lesser peasants, meaning they got some stronger position. This resulted in some serious rebelions, reductions of the peasant's chore, migrations to cities, etc., lying down foundations for onset of the renaissance in Europe.
The game shows nothing of that.
Not to mention the fact, that the Bubonic Plague persisted after this first, big pandemic. It ravaged some parts of the continent on various occasions still in in-game XIV and XV centuries, and later (like the Great London Plague in the middle of the XVII century).
As for the upper classes, such highly contagious illness surely did affect them. F.e. it claimed the lifes of Alfonso XI of Castille or Joan the Lame, queen-consort of France.
In-game? Its only another plague, maybe with higher kill-count, but still...with no flavour added. To be honest, it should inflict serious drops in taxes, reduce supply limit - I mean, harsher then those caused by other epidemics. Furthermore, it should also kill parts of the holdings troops and levies, and, after passing, give some boost to the rebellion risk (or, perhaps, fire some chain event, like "peasants demand more freedom" with some small historic note, an option to aknowledge them with penalty for feudal and clergy vassals, or to dismiss them, giving +50% to revolt risk in some provinces or starting a huge peasant revolt outright).
That actually happened to me... I guess it really depends on the game. Very early in my game I got hit really bad with a series of diseases (1090s-1110s or so I think?). As soon as one wave of disease cleared up another started infecting all my counties. I'm pretty sure that all my vassals died along with about half my court and a good chunk of my family.
In the end I didn't actually lose anyone too important and some guys that were causing problems dropped dead without me having to... intervene, hehehe.
Btw, the great pox isn't the plague, it's syphilis
not quite true. its independant from the hordes, but it only starts after 1300 i think.