Completely depends on what you're doing. If you're doing a lot of sustained compute, or doing graphics, then yeah you're gonna want some cooling. But it's a useful little machine for all kinds of tasks which don't cause sustained high power consumption.
Two fried on me. One was just running a printserver without a case. It was in summer so ambient temperature was around 32C but still, you telling me you use rpi 5 without even a cooling case?