I absolutely think there should be ramifications for such acts. What I find bizarre, is that China and Russia do this daily, and "oh well". If such states sent over people to, you know, do damage using a bomb instead of a hack, there'd be trouble. As in, two towers were damaged, and it set off 20 years of war ... mostly against the wrong states. Yet if you cause death via subtle means, such as reducing hospital infra…
The only reason the US government doesn't make a big deal about hacking is because they dont want blowback from their own intelligence collection operations. It's like how every country knows embassies are full of spies but they let them operate as diplomats anyway because they do the same thing.
Or in Iran’s case, they don’t.