play dead is dead. Plenty of penalty there. Thats the only way I like to play. Makes every decision or encounter matter. water is going to be much harder to come by A21, so survival will certainly get harder.
There are so many settings available to increase difficulty. Too much loot, lower it. Too easy to kill zeds, increase difficulty. Dont need a base for a long time. Make horde night every night.
The settings are there, and TFP has done a great job of giving us the flexibility built into the framework to achieve the desired game configuration.