So there is a sort of bug with the Spilled Blood questline where if you are playing a character who has already maxed out their Plague Ichor, and you make a new realm. Since you can no longer use Plague Ichor once you max out everything the Spilled Blood questline wont progress, and when you reach the current endgame to unlock Outbreaks, the quest wont progress.
Since the quest wont progress the scene where the Watcher, Roan, and Governor Ellsworth tell you to stop the Outbreaks wont happen, and you are basically stuck and unable to get Outbreaks. The only solution I have found was to create a new character, go into that realm, spend some Plague Ichor. After that the quest will go back to normal, also this bug will also affect the progress another quest, Spoken and Unspoken, where Roan won’t appear at where Danos is.