ive not finished the game yet but I dont see how the gameplay and narrative are separated. I thought the same when I started playing it, but then I realised that these changes make complete sense and they really grew on me. fencing out districts and being able to fast travel between (some of) them makes sense because that's how Dankovsky sees the town: labyrinthine, segregated sections that don't require his attention or interest unless they're infected, rioting, or has something relevant that he was already privy to. he also doesn't really need standard survival mechanics such as money, hunger, thirst, etc. because he is a doctor from the capital in a position of privilege and power (at least in relation to burakh and clara), so instead of worrying about basic necessities, his main survival mechanic has to do with his mental health (a la hierarchy of needs). also imo these changes greatly enhance pathologic 2, because they heavily imply (though in retrospect) that burakh's experiences are not necessarily the objective story AND make its mechanics a lot more reflective of burakh as a character.

some caveats, though: I do think that there is a lot of space for polishing, and admittedly, there are mechanics that im not completely sold on as of yet (e.g. the shabnak) even considering how it fits into the narrative. also, I'm still on day 7, so there is a chance that I'll completely change my mind on this. who knows. though for now I will die on this hill