Boston is just a different beast than what it was 20 years ago. Even if you were just marginally talented (like me), you didn't have to run as hard in your qualifying race to make it into Boston. Qualifying times were easier and applications were first come, first served, so there was no imaginary cut-off time to worry about. Hell, they would even give you up to 59 seconds past your QT and still let you in. Basically, you could run your qualifier, then go race Boston.
Because of faster QT times and the 5+ minute cut-offs, those marginally talented people (like me) now have to push themselves to (or past) their talent levels to get in. Others are using downhill courses to qualify, and then not adjusting their pace appropriately for Boston's hills. In any case, lots of these runners could use a year's rest, but instead, they're running Boston 6 months after a hard marathon effort and they are semi-cooked. Couple that with temps they're not ready to run in, even if those temps don't appear to be overly warm, and you're going to get a lot of blow-ups.
Having run in 2006 and 2019, I can see the difference as I described above. My advice... race your qualifier, then go have fun at Boston.