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to be exact it adds "Freezing to Death" and "Water-born diesases" - it also tweaks the seasons of crops so that they are reflective of more realistic conditions (specific seasons per crop). I play with it but only use the water-born disease portion on my server - I tried playing with the tempeture at first but after spending nearly all of winter indoors, underground, next to an open fireplace you get sick and tired of "Waiting to warm up" so i disabled it come spring when i noticed even going outside in spring at night freezes you to death in warm clothes like wool.
It doesn't add: Air and Food/Water are handled by the same "Starving Alive" System as vanilla.
Funny Story: I idled the last 3 (real) days of winter with the server open just trying to "wait out" the arrival of spring before going back in game - total fail.
The issue with any survival mods, is when they try to implement a cold factor. Skyrims survival mod is horrible for this one too.
Granted you would likely freeze to death, if you tried to sleep overnight in the winter as either Wurm or Skyrim have it, but you certainly wouldnt freeze 30 mins travel to your door from a fire. Especially not in wool lmfao
It could even be argued that you would be able to survive overnights with wool clothing, provided they stayed dry.
Savage Lands is another one that is terrible for their implementation of the cold factor.