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I finally had a chance to sit down with this and write up a review.
First thing I'd like to state is that you do NOT need to be running an apocalyptic world in order to make use of the material here. Anne's done a great job of making all parts of the book adaptable to relatively thriving worlds as well. The threats presented as being apocalyptic need not affect your entire world - it might only affect a particular region or city (in fact, there's a whole section of the book devoted to explaining localized apocalypses). If you were thinking about skipping on the book because you don't want to bring an apocalypse to your worlds, think again.
Chapter 1 is perhaps the most directly tied to being in a true apocalypse. It offers adventure ideas and advice for how to shift the culture of a world to adapt to an apocalypse. My favorite part of this chapter is the "Born in the Apocalypse" topic, which aptyl points out that no apocalypse is likely to wipe out all living beings. Small communities will survive, and life will "go on" in some fashion, but the nature of that life will be drastically different. People born into such a setting have "no concept of government or massive cities" and are likely to experience danger from a very young age. This ties in nicely with the revised character backgrounds and new backgrounds presented in chapter 7.
Chapter 2 presents ideas for creating apocalypses/mega threats, going over rules for how to incorporate them, as well as advice for overcoming potential limitations that existing D&D 5e rules might present to running this effectively (e.g., some classes being immune to disease, and the Turn Undead feature). I have some reservations about the work-arounds suggested, but that's barely a dent in the design. What's really cool about this chapter is it not only gives you rules for specific kinds of threats, but also explains how people and settlements adjust to a world in which this threat is prevalent.
Those of you running Baldur's Gate: Descent into Avernus and looking to continue the adventure might find The Rapture or The Inferno events useful in for preparing a world after the events of that campaign.
My favorite part of this chapter is probably the creature templates provided at the end of each threat. I had made something similar to the cinder beast in the past, and it was great to see it here! The artwork is especially gorgeous.
Chapter 3 There's a lot of settlement-building advice here, which can easily be adapted to simplify modify existing settlements in an ongoing campaign. The chapter presents a few different types of "government" or "rulership" that might spawn from catastrophic events. While they are all logical possibilities, I would have also liked to have seen an attempt at describing an anarchic yet peaceful society...something similar to that portrayed in a book called The Dispossessed. Or maybe that's better suited for an actual adventure.
Chapter 4 presents optional rules for running a gritty game, some of which are adapted from existing official sources and others original. I especially love the Material Component for Healing Spells and Additional Rest options, which are elegantly designed and can be incorporated into any game without game-breaking consequences. I say this as a DM who very rarely uses any optional rules at all (even flanking).
This chapter also has rules and tables for scavenging that can be used in any setting. It truly enhances the exploration pillar of the game and incentivizes taking skill proficiencies beyond just the Perception skill. It reads very much like it was written by an empathic DM who wants each player to be able to contribute to the group's progress. Icing on the cake here is the Sign Language and Stress and Trauma sections, which are incredibly elegant themselves and don't needlessly veer away from the core of 5e design.
Those of you running Out of the Abyss will find this chapter incredibly useful. The Stress Levels system makes for a great a supplement to the official Madness System (and is arguably less mechanically devastating than the Short-Term Madness effects).
The only part of this chapter I have some reservations with is the Physical Trauma section, but I have the similar feelings about the official Lingering Injuries tables. I generally don't like them in 5e. However, the traumas presented in this book are somewhat superior to the official ones, because instead of using an "all-or-nothing" approach to make things "elegant" (a common pitfall of 5e rules), Anne actually digs deeper and presents a set of rules that focus only on very specific injuries, instead of applying wide-spread debuffs. I always appreciate that kind of design, even if I am unlikely to use it. It's the sign of a creator who has a great sense of what can potentially frustrate players.
Chapter 5 and chapter 6 present some unique, thematic races and subclasses. I am in a bit of a "player option bloat" right now, so I haven't read this in detail and am unlikely to use it. All I'll say is that the flavor looks very compelling, and the artwork is quite gorgeous. Also, having read the other crunchy bits of this book, I'm positive that Anne has a sound understanding of 5e's mechanics and you are unlikely to be disappointed in these chapters. The book is worth its price even if you choose not to use these chapters.
Chapter 7 describes how a catalclysmic event can alter the existing backgrounds presented in the PHB, and also presents some compelling new backgrounds. Flavorful revisions to the backgrounds are very insightful and presented concisely, making for a very easy read. This makes it easier for DMs to explain to players how their character's backstories might be different in an apocalyptic campaign. In addition, the new backgrounds do not feel like they were simply tacked on for the sake of providing crunchy options. There is a lot of compelling lore attached to them, and some of the features are very relatable, such as the Afflicted's Not Long For This World feature. (Speaking of the Afflicted, why do they gain proficiency with a gaming set? Seems out of place, based on my understanding of this background).
Chapter 8 In this final chapter, we are presented with some really cool monsters: The four horsemen of the apocalypse, their mounts, a CR 30 boss monster, and different types of vampires.
The four horsemen are very elegantly designed legendary monsters, smartly placed at CR 21 to prevent true polymorph shenanigans, while also not requiring a tier 4 party to defeat. Each of them also have the Shapechanger trait, which provides lots of roleplaying opportunities. This works on their mounts as well!
Speaking of mounts, I LOVED reading their stat blocks as well. The mounts are intelligent and have some very flavorful traits (such as Despair's Visage of the End). You can very well use the mounts alone to terrorize PCs/NPCs, foreshadowing the arrival of their masters.
The vampire variants are also flavorful, and their art is grotesquely evocative (that's a good thing). The only thing I'd change here is give the Bruxa some Legendary Actions.
Overall:
This is a book no Dungeon Master will be disappointed with. It has content that will be easily transferrable to a hypothetical future edition of D&D. Anne's writing communicates to the reader very effectively, as though she's having a conversation with you. The crunchy bits seem to come from someone who has a competent level of interpersonal understanding at her tables, understanding what the core rules are missing and what they excel in addressing. There's nothing here that feels like it was just added to spam content...everything serves a compelling purpose.
If nothing else, this book makes for an excellent read in our current circumstances. It's not in-your-face pessimistic or depressing as I expected - in fact, there's some morally uplifting material here as well. It made me motivated to take on cataclysmic events, both IRL and in-game, rather than sink into despair.
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