The big companies and official government accounts refuse to move, and the only real alternative is Facebook, which comes with its own set of issues. Plus, users in foreign countries like Asia aren't involved in US politics and debate and haven't noticed any real changes except that big, stupid X.
It's mostly political content that's filled with right wing trolls and paid nation state bot runners. If you're in more obscure communities that Russia / China / Right wing corpos aren't interested in, it's just business as usual.
I'm actually surprised it isn't available by default, as alternative control schemes like this in isometric RPG's is as old as Neverwinter Nights 1 back in the early 2000's.
Larian seems to have great attention to detail, so I wonder if they'll add it in a patch.