I expected it to be a little less convenient to leave Microsoft's beaten path. I did not expect it to be a massive waste of time. This is what I meant by futile. Not only is it apparently very brittle, it's missing large swaths of VSC's ecosystem. Hell, I don't even know if the extension I wanted is available on OpenVSX because it's still down!
If Microsoft hadn't openwashed their product, I wouldn't care nearly as much.
Besides, Emacs still provides a streamlined system for managing packages on top of being hackable. It even makes installing and upgrading packages straight from a Git repo easy. Sometimes you can have your cake and eat it too.