[mixedCase]

> Testability, tooling and the open-source ecosystem and either bad or non-existent

If you're properly testing the code in your application that exercises persistence, that means your test harness runs a real database like the one you're running in production and thus you can also write the database logic tests using your own application's testing facilities.

Of the things you listed, "the database sends e-mail" is the only one where I'd think you'd have to change the code at all, and have the database go through a mockable middle-man so that it becomes testable; but everything else can be comfortably tested from a test suite that is able to talk to a real database.