They mention autvacuum_vacuum_scale_factor, and its default value, but give no hint if they tried to change that. Obviously I have no access to their database, but one of piece of advice for ages has been, in situations similar to theirs where a lot of dead tuples accumulate and autovacuum is having trouble finishing, to lower this value so autovacuum runs much more often, so each run has less to do and less gets blocked.