What are you going to do with their identities at that point? These are real people. If you ban them, you're banning the innocent victim rather than the attacker who still has 49,999,999 more accounts. But if you let them recover their accounts or create new ones, well, the attacker is going to do that too, with all 50 million accounts, as many times as they can. You don't know if this is the attacker coming back for the tenth time to create another spam account or if it's the real victim trying to reclaim their stolen identity.
So are you going to retaliate against the innocent victims by banning them permanently, or are you going to let the attackers keep recycling the same identities because a lot of people can go years without realizing their device is compromised and being used to create accounts on services they don't use?
I guess you could have an eyeball scanner at your computer that only sends out a binary "yes this person is human" to the system every time the log in. That sounds expensive and hackable and just janky though.