I failed to find an answer to the main question: what output languages are supported. The only way is to emit OpenAPI and then using one of their terrible generators?
You can create your own emitters, there's info in the docs on how to do so. My team built a custom TypeSpec emitter to output a SDK and set of libraries
I'm the TypeSpec PM at Microsoft and I'd like to learn more about your use case and experience building a custom emitter. Are you willing to chat about it? If so, what's the best way for me to reach you?
There are a few emitters in our standard library - OpenAPI 3.0, JSON Schema 2020-12, and Protobuf. REST client and service emitters for a few languages are coming online now and should be ready in the next couple months.