Cities and industrial sites are the exception with bad air quality, not the default.
That said, I live in SF and my AQI is usually <50. Not as great as 5, but we sometimes get down to single-digits. Cities don't have to have bad air.
Haven't heard of them from grand-designs and those kind of youtubers)
just some ideas what some (public)/most (nice home) japanese toilets offer, which might be hard to come by anywhere else
They are $200-300 online. Not Toto quality, but plenty good enough.
With an ERV you can control how much air you get, and put whatever filter you want in between the outside air and your room.
In fact the fancier systems will let you overpressure your house by running the fan pushing in slightly higher than the air pushing out, ensure air only leaks out of your house not in.