I always suspected this game was going to be abandoned by the dev. I really loved the game in its earlier iterations and the premise seemed great, but it was pretty clear that the developer never had a solid plan in place.
The Regional Manager was a game ruled by Patreon polls, resulting in feature creep and a generally disjointed experience all around. It definitely seemed like Horizontical had some clever ideas in mind but he ultimately caved to his supporters, sometimes even adding in content that he himself personally thought didn't fit the narrative. I was even one of his Patreon supporters and watching those poll results come in and Horizontical's responses to some of them was disappointing. Seemed like he really didn't want to add some of the crap that got added, but he felt obliged to since that's how he set the entire process up...
This is a fairly common end-result of games in development being controlled entirely by Patreon polls. It's always a mistake to relinquish that level of creative control--polls should be for minor features or additions that you as a developer are already interested in making. Horizontical would usually just ask his supporters to message him with any ideas they had for content, and he would add those ideas to a poll for all other supporters to vote on.
Sadly, this was inevitable. I'm glad we got what we did, the game itself is an enjoyable romp in power fantasy/humiliation type of content, but it was always going to end this way. I hope Horizontical's next project--likely under a different developer name--is more focused on what he wants to make, not what us gooners tell him we want. (Yes, some of my submitted ideas made it into the game, and no I don't think it was a good idea--my ideas weren't even successful in the polls so clearly they weren't good ideas...)
I don't believe the health crisis nonsense. That's one of the most common things H-game developers use as a crutch to get financial supporters off their backs. Horizontical likely just got burned out working on a project he didn't enjoy anymore. It's fine. He put around four years of his life into this project, that's far more than most developers accomplish before burnout.
To be clear, I hold no animosity toward the guy. In fact I wish him luck in the future and hope he continues making games. I honestly hope he's already working on a different project under a different name and we're all just none-the-wiser. Assuming he didn't enjoy working on The Regional Manager anymore, I feel like that's the best case scenario here.
Good luck, dev. Thanks for all the fun!
(aaaand I'm off to replay this game again, because why not)