the most logical solution for follow list hell would be shifting the storage of follow lists to a consensus driven data system, so you can just add and remove instead of blasting out the new version every 5 seconds as you click follow on a thread with a hell client that enables insta-following

or a modification of the "replaceable events" protocol that allows you to just send a change that is +/- pubkey each time and that the database keeps them together and prunes off the outdated data

it's a problem that probably nobody wants to deal with but it has a nasty collision with the limitations of websockets and the inefficiency of hexadecimal encoded pubkeys

in fact, you could just add a add/remove protocol to this it just means that searching for this kind of event has to be exhaustive like a bitcoin utxo provenance verification (which is most of what the processing in initial block download is for)