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(+2)

Although I won't include death in the game, I'll be expanding the health system in a mini-update that I'll release before the next big one.

This could work like you describe, but the threat would be girls being hospitalised rather than dying. Maybe the symptoms could worsen and become harder to manage the heavier the girls get.

(+2)

Maybe if you don't take care of them good enough, they became fed up with you and totally was their hands of you, essentially removing themselves from the game.