Banshee's Screaming Affliction

Up to 4 creatures of your choice that you can see within range and that can hear you must make a Constitution saving throw. A target automatically succeeds on this saving throw if it can't be charmed, is currently deafened, or by nature does not need to breathe. On a failed save, a target is affected by this spell.

The target begins to scream uncontrollably with as much force as their lungs can possibly muster in one breath. They must reroll their Constitution saving throw every 30 seconds (every 5 turns) for the opportunity to inhale, and cannot cast any spells requiring a verbal component. Three consecutive successes breaks the spell; otherwise the target must succeed on at least 5 saves and never fail more than twice in a row within the duration of the spell. The target takes 1d8 force damage for each failure. After 5 total failures or 3 consecutive failures, the target falls unconscious for at least one turn, and takes no further damage from the spell unless and until they reawaken before the spell ends. Creatures that drop to 0 HP before the spell ends die bleeding from every facial orifice. Creatures that survive with 4 or fewer HP must take a level of exhaustion upon reawakening.

An unconscious target will reawaken after 1 turn if it takes damage or if after another creature uses its action to wake the target up. If the target reawakens before the end of the spell's original duration and before it has been dispelled, the effects of the spell resume for the time remaining.

Secondary ranged effects. Screaming with such force is severely and indiscriminately disruptive, at least at first. Any creature under this spell's effect automatically fails all Stealth checks, as the screams can be heard from up to half a mile away in optimal conditions. All hearing creatures within 150 feet, with an unobstructed line-of-sight to the affected and no ear protection, have disadvantage on Perception checks that require hearing, including the original spellcaster. Within 60 feet of a newly-affected target, any creature apart from the original spellcaster that is actively maintaining another spell via concentration must succeed on one Constitution saving throw or their spell will break. Spells cast after the screaming has started are not subject to this check.

At Higher Levels. The spell's duration increases by 5 minutes, and the number of possible targets increases by 1, per spell-casting slot level above 4th. The success-failure ratio needed for the target to survive remains constant, and the effects of 3 consecutive successes or failures remain the same, respectively. At 9th level, any creature with below 100 HP that is still under the spell after 1 minute dies.