The problems I see with Lemmy performance all point to SQL being poorly optimized. In particular, federation is doing database inserts of new content from other servers - and many servers can be incoming at the same time with their new postings, comments, votes. Priority is not given to interactive webapp/API users.
Using a SQL database for a backend of a website with unique data all over the place is very tricky. You have to really program the app to avoid touching the database and create cached output and incoming queues and such when you can. Reddit (at lest 9 years ago when they open sourced it) is also based on PostgreSQL - and you will see they do not do live SQL inserts into comments like Lemmy does - they queue them using something other than the main database then insert them in batch.
email MTA apps I've seen do the same thing, they queue files to disk before putting into the main database.
I don't think nginx is the problem, the bottleneck is the backend of the backend, PostgreSQL doing all that I/O and record locking.