For example at most good crypto companies that hold wallets it's not possible to ssh at all, even if someone asked and go permission. It just simply isn't possible short of having a AWS root key or physical access to a computer in a DC.

There is no login, no accounts, no ssh keys or similar, they are immutable containers running from images with a signed SHA. The SHA can only be built by a build system that has it's own set of strict security controls.

Without details, I don't know why a comproised laptop would make any difference unless it submitted code through a PR and had it approved by multiple people.

A good solution to this is to have a "break glass" system. Ie. access permissions get granted to the developer directly in an emergency by going through a set of steps available beforehand. All requests by that developer are then allowed, limited to 10 kilobytes of results per minute and logged.

For example, imagine you run a bank, and a rare code bug means that at exactly midnight on new years eve all bank balances have $1B added to them.

Your oncall takes down the production servers to to reduce losses and uses the break glass system, by getting approval from n other developers, allowing them direct database access. They use that access to count(accounts) with a balance around $1B or more, see it is everyone, and subtract $1B from them all, before bringing production back up with an older software release. Downtime = 2 hours.

In the morning, all the developers actions are reviewed.

If the developer turned evil and trying to dump the database, the n approvers and 10 kilobytes per minute would reduce data loss. But the break glass system still lets the developer make fairly major emergency fixes to reduce losses or downtime.