Malaise

"It itches so bad. Belly aches. I scratch but then I bleed... headaches, blurred vision... feel down and so itchy."

The Malaise, also known as the Plague, the Gloom, the Infection, and the Green Poison, is described as a virus that has been infecting the island within the Dead Cells world.

Malaise as a mechanic is introduced into the game at 4 Boss Stem Cells. It is a meter that has tiers that activates different effects at set tiers. Malaise can also be decreased by killing enemies, elites and bosses.

Malaise can be enabled in Normal, Hard, Very Hard and Expert difficulties using custom mode.

Malaise can be turned off using custom mode Disables achievements

Mechanics
Malaise starts building up when you break the door that seperates the start area of the actual biome in the Prisoners' Quarters. Malaise will keep increasing alongside gametime, whenever gametime stops malaise will stop increasing and its effects are disabled. This is in shops, lorerooms, treasurerooms, challenge rifts, biome transitions and bossrooms. Malaise can be decreased in these rooms.

Increasing infection
Malaise has 10 tiers, each being 50 points adding up to a total of 500 points at maximum. Malaise increases constantly at a rate that correlates with the amount of enemies that are alive in the biome. On 100% enemies remaining it takes approx 42 seconds to fill up a tier.

The only other source that increases malaise is infected food found in wall secrets.

There is a small cooldown of 0.35 seconds after an increase before it can increase again.

Reducing infection
Decreasing the malaise is mainly done by killing enemies. Each kill of an enemy decreases the malaise meter, this includes enemies spawned by the malaise. When you have killed enough enemies you have cleared the infection in the biome and trigger the clear infection event. This occurs when you have killed 90% of the enemies in the biome. At this point the malaise stops increasing and the effects are disabled. Your malaise wil also decrease by the amount of points you would get from killing the last remaining enemies, but all at once. Killing them after the event does not decrease malaise any further.

Other sources to decrease malaise is your health flask and cough syrup bought in food shops.

Effects
Malaise effects enemies and their behavior and stats in different ways. Some boost existing stats or ablilites while some are exclusive to malaise.

Stat boost
Malaise increases the speed at which enemies move and attack as well as boosting the damage the do.

Teleport
Teleport is a mechanic from 4 and 5 Boss Stem Cells. Malaise increases the speed at which enemies teleport and even increases the range at which an enemy can aggro another enemy to teleport to the player together.

Enemy spawning
Malaise will spawn random enemies around the player, appearing to crawl out of the ground. The enemies that are able to spawn are not limited to the current biome.

Elite transformation
Malaise makes it so enemies can transform into elites. When an enemy is going to transform it kneels and charges the tranformation for a few seconds. Transformed elites do not have random abilities.

Origin
The Malaise has no clear origin. During the Alchemist's search for a cure, he theorised about where it came from. He states that some think the Malaise originated from the Slumbering Sanctuary: the sap there seeped into the Sewers, spreading the illness. The Alchemist also notes that the island's insects likely helped spread the virus. Piles of infected bodies were dumped into the sewer, and the infection appeared to rampage from there, although the Beheaded is unsure if they were dumped before or after the epidemic started.

Effects
The Malaise's symptoms include vomiting blood, itchiness, headaches, blurry vision, bellyaches, and feeling down. Left untreated, the Malaise leads to certain death. Since the infected were imprisoned and quarantined, the Malaise appears highly infectious.

The more extreme effects of the Malaise are highly unsettling. Mutations begin, and sometimes the corpses begin moving on their own. The end result of the final stages of infection is reanimation into hostile, mutated undead.

The virus affects humans and animals. Conjunctivius was a result of the mutations, and the Concierge was a victim of the virus as well. Meanwhile, the Beheaded's true entity is immune to the Malaise and only the bodies it possessed are vulnerable.

Treatment
Later into his research, the Alchemist found a way to reduce symptoms from infection, as well as a method for slowing down mutations. This was likely synthesized with the sap found within the Slumbering Sanctuary, which he suspected could provide the cure.

It appears that the Time Keeper had successfully kept the Malaise at bay via time manipulation, but it seems that this is exhausting to her, and the Alchemist suspects that time will not contain it forever.

Impact on the island
There is little sign of what the Island was like before the Malaise debuted, although it must have been at least somewhat prosperous. However, any chance at a good future on the Island was ruined by the Malaise and the King's response to it. The island's citizens faced civil unrest and focused their rage on the King, due to his cruel reaction to the appearance of the Malaise. The King demanded that the infected were to be imprisoned and hanged, even just upon the suspicion of infection. Eventually, he demanded that nobody was to be let out of the prisons, even if they served their time. What little of the villagers who remained on the Island met their deaths at the hand of the Malaise and the undead, or were slowly awaiting it locked away within the prisons.

Trivia

 * The Malaise could have possibly been influenced by the Black Death.
 * Bupleurum is directly referenced as a way to minimize the symptom of the Malaise.