PlatformIO does not depend on VSCode. You can do everything from the command line. And then script and automate it to you heart’s content.
I don’t have VSCode installed. I tend to develop using lots and lots of small main apps (see Here is a simple way to have many small "main" apps) and in fact often fire up a background script which watches for file changes and automatically re-compiles, re-uploads, and re-runs specific apps while editing. With auto-save in an editor, all it takes is switching window focus, which is part of the normal workflow anyway. I call it Continuous TDD, but no doubt many others have done the same thing.
I don’t really understand how anyone can move cursors and push buttons all day long, or press the same series of key combinations over and over again.