Here's a gentleman who put malicious firmware on a hard disk to bypass linux security by serving a neutered /etc/passwd file. http://spritesmods.com/?art=hddhack
Generally, you have to choose the level of rebuild that you can live with given your likely attacker. Usually, flashing firmware is dangerous and likely to alert the operator to the infection, so most attackers interested in spam/phishing wouldn't try that approach. That is probably some three-letter-organization level stuff.
Also, if you happen to know of any Linux utilities that can flash a live OS's HDD firmware without the system going to shit, I'd be curious to learn more.
If this is the case, then EC2 wouldn't work. Anyone with a VM could own the host (since they have root on their own VM?).
edit: at the very least I'd recreate the VM from scratch.