With such a realistic game world, the next consideration should be how to make it enjoyable for players.
Its realism has a significant advantage, as it provides a greater sense of immersion. However, there's also a notable downside, which is that the gameplay might not always be fun, for instance, getting hit actually hurts, hunger sets in if you don't eat, thirst if you don't drink, carrying items can be tiring, and monsters can attack at any time. Even though there are life-saving amulets to provide a final line of defense, the process is clearly not always enjoyable.
But its greatest advantage is the ability to teleport into the game world upon entering and return to the original location upon exiting, which makes it extremely convenient. The downside is that personal belongings can't be taken in or out.
