It is some years ago since I operated in this band. In recent years there are far more countries on the band and some commercial gear covering the band, During the Es season some reasonable DX should be possible with very simple antennas and low power on SSB or FM.
Many years ago I designed a simple QRP transverter. Despite a very poor antenna some good GDX was worked.
The design appeared in GQRP SPRAT some years ago.
It seems amazing this was over 10 years ago!
UPDATE Feb 7th .2022: A local has a personal beacon on 4m. He is 3km away and the beacon is 10mW to a vertical. As I have no antennas for 4m, I used my triband vertical V2000 omni and the 2m big-wheel. Perfect copy.