Survival mode is now available. I tested it out with my current character and it is just a bit too much for me. Adrenaline, sleep depredation and thirst all kicked in really fast. I could probably manage these and the diseases but the carry weight changes and no fast travel would just suck the joy out of it for me.

Now the proud member of the Benevolent Leader club! Have no clue what kicked it in gear but killing Trashcan Carla seemed to do the trick for me.