From what I remember, GKE has implemented an etcd shim on top of spanner as a way to get around the scalability issues, but unfortunately for the rest of us who do not have spanner there aren’t any great options.
I feel like at a fundamental level that pod affinity, antiaffinity, and topology spreads are not compatible with very large clusters due to the complexity explosion in large clusters.
Another thing to consider is that the larger a cluster becomes, the larger the blast radius is. I have had clusters of 10k nodes spectacularly fail due to code bugs within k8s. Sharding total compute capacity compute capacity into multiple isolated k8s clusters reduces the likelihood that a software bug is going to take down everything as you can carefully upgrade only a single cell at a time with bake periods between each cell.