Pandemic: Reign of Cthulhu – Leash the Madness!

Pandemic: Reign of Cthulhu - Leash the Madness!
Pandemic: Reign of Cthulhu

Pandemic: Reign of Cthulhu

It’s no secret that I’m an avid Pandemic fan. And not just of the base game and its expansions, I love its spin offs Forbidden Island and Forbidden Desert, too. So, of course I immediately preordered Pandemic: Reign of Cthulhu when I heard the first whisper of its coming. Now it’s here and I can’t wait to tell you about it.

How’s Pandemic: Reign of Cthulhu different from regular Pandemic? That’s the question I’m asked the most often, so I’m going to focus on answering that, noting the most important differences in bold.


In Pandemic: Reign of Cthulhu, your goal – and the only way you can win – is to seal the four gates through which the ancient and terrible Old One, Cthulhu, seeks entrance to our world. The fate of humanity again rests in your hands, for should Cthulhu awaken, an age of chaos and madness will reign and mankind will be lost to madness. Wow! That’s a heavy burden to bear.

Of course in typical Pandemic style, while there is only one way for you to win – seal the four gates – there are numerous ways to lose:

  • You have to place a cultist, but there aren’t any left. This is similar to needing to place a disease cube in Pandemic and not having enough.  However, there’s only one type of cultist to supply the entire board when you reveal Summoning Cards at the end of each player’s turn in Reign of Cthulhu, so they can run out quite quickly.
  • A Shoggoth is summoned, but you don’t have one to place. There are only three Shoggoths. There are four Evil Stirs cards (the equivalent of the Epidemic cards in Pandemic) that always summon a Shoggoth as one of their steps. If the Old One Hathor awakens, it summons a Shoggoth. If you don’t have one to place, you lose. Shoggoths are also more difficult to defeat than cultists: it takes 3 Actions to defeat a Shoggoth. Simply encountering a Shoggoths poses a risk to your sanity (see Sanity Rolls below).
  • It’s the end of your turn and there aren’t at least two Player Cards left in the deck for you to draw. This is one of the most common ways I lose at regular Pandemic.
  • All of the investigators (players) go insane. It is the Reign of Cthulhu, after all. Dealing with Old Ones and their associated chaos takes a toll on your sanity. (see below)
  • The last Old One, Cthulhu, awakens. Game over, man!


Pandemic: Reign of Cthulhu - sample roles

sample roles

Set up of Reign of Cthulhu is similar to Pandemic, with a few small differences:

  • Place the Old Ones, 6 random, face down in the spaces across the top of the board. Cthulhu always goes in the rightmost spot (X). 
  • The player who most recently read a horror story goes first.
  • To assign roles, shuffle the seven Investigators and turn up two. The first player chooses one to play. Then turn up another so the next player has two to choose from, and so on until all players have a role to play. Each Investigator Role has it’s own special ability. Many are similar to those found in original Pandemic. For example, the Hunter works much like the Medic, the Doctor gets 5 actions like the Generalist, the Detective only has to discard 4 cards to Close a Gate like the Scientist to Find a Cure.
  • To seed the board with cultists, flip over two cards and place three cultists on each of those locations. Then flip two more cards and place two cultists there. Flip two more and place one cultist on each of those places. This is similar to Pandemic, just with fewer cards. And finally – this is new – flip one more card and place a Shoggoth there.
  • You’ll prepare the Player Deck in much the same way, shuffling in 4, 5, or 6 Relic cards (equivalent of Special Event cards) for 2, 3, or 4 players respectively. After dealing 4, 3, or 2 cards to each player, depending on the number playing, break the deck into four mostly equal parts and shuffle an Evil Stirs card into each. Then stack them up to form the Player Card Deck.
  • Set the deck of unused Relic cards near the board. Whenever you defeat a Shoggoth, you get to draw one.

Adjusting the Difficulty

You can adjust the difficulty of the game by removing Clue cards from the Player deck before adding Relic cards to it. There are 44 Clue cards in Reign of Cthulhu: 11 for each Town (Arkham, Dunwich, Innsmouth and Kingsport). These are similar to the City cards in Pandemic, but not as specific.

  • For an introductory game, you don’t remove any Clue cards.
  • For a Standard Game, remove 1 of each color.
  • For an Expert game, remove 2 Clue cards of each color.

The smaller the deck, the less time you have to complete your mission before Cthulhu awakens and reigns supreme.

Pandemic: Reign of Cthulhu components

Pandemic: Reign of Cthulhu components

Game Play

Game play in Pandemic: Reign of Cthulhu is quite similar. On your turn:

  • Perform 4 Actions.
  • Draw 2 cards from the Player Deck. Hand limit is still 7. Evil Stirs cards replace Epidemic cards.
  • Summoning, which is essentially the same as the Infection Phase in Pandemic. You draw Summoning cards up to the current Summoning Rate (noted under the rightmost revealed Old One), placing one cultist on the specified location.
    Pandemic: Reign of Cthulhu - Shoggoth symbol

    Shoggoth symbol

    • There are no Outbreaks. If a location already has 3 cultists, the cultists successfully Awaken an Old One: perform an Awakening Ritual (see below).
    • Shoggoth Symbol on Summoning Cards. If a Summoning Card has a Shoggoth symbol on it, move all of the Shoggoths on the board one location closer to the nearest open gate. If a Shoggoth is already on an open gate, return it to the supply and perform an Awakening Ritual.

Player Actions

Pandemic: Reign of Cthulhu - bus symbol

Bus Station symbol

Player Actions are quite similar to those of regular Pandemic. Movement Actions include:

  • Walk. Similar to Drive/Ferry. Move one location.
  • Take the Bus. This works two ways and is a little different than the Direct Flight and Charter Flight movement in Pandemic.
    1. While at a Bus Station location, discard a Clue card to move to any location in the town pictured on the card.
    2. While at a Bus Station location, discard a Clue card matching the town you’re in to move to any location in any town.
  • Use a Gate. Move from one Open Gate location to any other Open Gate location. This is just like taking a Shuttle Flight between research stations, except research stations don’t close. After using a gate, make a Sanity Roll.

Special Actions:

  • Defeat a cultist. This is the same as treat disease. One action removes one cultist from the board unless you have a special ability that says otherwise.
  • Defeat a Shoggoth. This is new and requires 3 Actions to accomplish. Draw a Relic card after removing the Shoggoth from the board. Don’t forget to make a Sanity Roll if you moved into the Shoggoth’s location.
  • Give or Take a Card. Like Pandemic, if you want to give or take a Clue card, you must be on the same Location as that depicted on the Clue card in order to exchange it. You can give or take a Relic card simply by being on the same location with another player.
  • Seal a Gate. While at an Open Gate, discard 5 cards that all match the town you’re in. Place the matching Closed Gate Token on the gate to denote its closed status. You cannot move through Closed Gates. Remove 1 cultist from each location in the town you’re in. If you’re Insane, you immediately recover your Sanity and are transported to either the Church or Hospital – your choice.

Awakening Rituals

This is something completely new and different in Reign of Cthulhu. Awakening Rituals occur whenever:

  • You need to place a cultist on a location and there are already 3 present.
  • A Shoggoth on an Open Gate moves due to a drawn Summoning card.

To perform an Awakening Ritual, simply reveal the next Old One. Some Old Ones have an ongoing effect, notated with an infinity symbol. Others a one time, instantaneous effect. Both are bad news for the Investigators.

Sanity Rolls & Insane Investigators

Pandemic: Reign of Cthulhu role card

Sample two-sided Role card

One of the biggest differences between Pandemic and Pandemic: Reign of Cthulhu is the potential for Investigators to go Insane. Players start the game with 4 Sanity tokens with which to track their saneness.

If you lose all of your Sanity Tokens, your character goes insane. Turn over your Investigator card to indicate this. While Insane, you’ll have fewer Actions and your Special Ability is modified – usually doesn’t work as well.

Pandemic: Reign of Cthulhu - sample Relic card

sample Relic card

Dealing with Old Ones, encountering their weird, monstrous Shoggoths, and using their Relics and Gates all takes a toll on your sanity. So, you have to make a Sanity Roll (even if you’re already Insane) whenever you:

  • Travel through a Gate.
  • Use a Relic card. (Similar to a Special Effect card in Pandemic – doesn’t require an Action.)
  • Enter a location with a Shoggoth or a Shoggoth enters your location.
  • Draw an Evil Stirs card.

The Sanity Die is a special 6-sided die:

  • Two of its faces are blank: nothing happens when you roll a blank.
  • Two faces have a single Insanity Symbol: you lose one sanity.
  • One face has two Insanity Symbols: you lose two sanity.
  • One face has two cultist symbols on it. You’ve been accosted by cultists. Place two cultists on your current location.

Evil Stirs

Pandemic: Reign of Cthulhu - Evil Stirs card

Evil Stirs card

Evil Stirs cards, periodically drawn from the Player Deck after taking your Actions, are similar to the Epidemic Cards in Pandemic, with a few additional steps inserted:

  1. Fight the madness. Make a Sanity Roll.
  2. Awakening: Reveal the next Old One.
  3. A Shoggoth appears. This is similar to the Infect step of an Epidemic card, in that you draw the bottom card from the Summoning Deck. But instead of placing 3 cubes on that location, you’ll place a Shoggoth.
  4. Cultists regroup. Equivalent to Increase the Intensity of the Infection. Shuffle the discard pile and place it on top of the Summoning deck.

You, of course, then execute the Summoning step according to the current Summoning rate under the right-most revealed Old One.

Game End

The game ends when you close the fourth gate or one of the losing conditions described above occurs. Hopefully the former.

My Thoughts

The nicely crafted minis, replacing the usual cubes and pawns, and the dark, Cthulhu artwork definitely enhance the new theme. Pandemic: Reign of Cthulhu feels lighter and easier than regular Pandemic to me despite having additional things to deal with like Shoggoths, Sanity Rolls and Awakening Rituals. I feel like these additions just make the game more fiddly and random rather than adding suspense and difficulty. Of course, you usually see more randomness, often provided by dice, in thematic games than in Euro games. My tastes lean more heavily towards the latter.

If you’re a fan of Lovecraft’s Cthulhu mythos, I think Reign of Cthulhu is definitely worth trying. You certainly can’t beat the playtime: 40 minutes. Most Cthulhu-themed games run 1 to 4 hours.


Pandemic: Reign of Cthulhu supports 2 to 4 players ages 14 and up and plays in about 40 minutes. The age rating is most likely due to the theme. I don’t see any reason – other than theme, if you object to that – younger kids couldn’t play. Like all Pandemic games, game play is pretty simple and straightforward. I’d rate it between Forbidden Island and Forbidden Desert in terms of difficulty level.


Copyright © 2016 by Tina G. McDuffie. All rights reserved.
Photo rights retained by their respective copyright holders.

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