Really don’t want to open the Keegan vs rest of the world debate again, but I think it’s fair to say he’s proven himself to be competitive in international fields too.
He got 7th at XCM worlds in 2021 (2 spots ahead of Tiago Ferreira), 5th at UCI gravel worlds in 2023 and so on. He regularly beats Matt Beers, who regularly beats everyone else at Cape Epic (won 3 of last 4, 3rd in 2022) 
As others have said, clearly something is off with him to be performing this ‘poorly’.
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I saw a post of him fully off his bike at an aid station spraying his back with cold water. He is a tough guy and a big competitor, I don’t know if I have ever heard him discuss having an issue or struggling in a race. So I imagine it is a very significant problem.
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I’ve seen videos where you can se him coasting on pedaly sections while repeatedly stretching his back.
As someone who suffers from serious back pain from a bulging disc all I can say is kudos to him for hanging in there. Not to mention how talented you have to be in order to make top 15 on probably the hardest MTB stage race.
I feel for both Keegan and Matt.