Were Cooks the Largest Occupational Group to Die in the Pandemic?
On July 14 2021, an Imgur user shared a screenshot of a tweet claiming, in part, that “cooks were the largest occupational group to die in a pandemic”:
I wish Anthony Bourdain were alive today to articulate the insanity of living in a country where cooks were the largest occupational group to die in a pandemic and restaurant owners are pouting that nobody wants to work in restaurants anymore
— 13 going on 40 (@GothestSloth) July 1, 2021
That tweet was originally posted on July 1 2021 (archived here), and referenced a deluge of restaurant signs lamenting the fact that “no one wants to work anymore“:
A Labor Shortage in 2021? Viral ‘Signs’ Are Not Employment Data
The tweet was popular on Imgur as well as Twitter. It did not include a link to any data substantiating the claim that “cooks” were the “largest occupational group” among pandemic-related deaths in 2020 and 2021 — but the tweet was specific, and it appeared to be referencing possible data or previous reporting on the most at-risk professions throughout the pandemic.
It was relatively simple to locate articles making claims similar to that of the tweet. On February 2 2021, CNBC’s “Make It” published “Line cooks have the highest risk of dying during pandemic, plus other riskiest jobs: study,” reporting:
A new study from the University of California, San Francisco suggests that line cooks have the highest risk of mortality during the Covid pandemic — even more than healthcare workers.
For the study, which hasn’t been peer-reviewed yet [as of February 2 2021], researchers analyzed California death certificates for working-age people 18 to 65, during the first seven months of the pandemic. Then they looked at how the number of deaths increased in that time frame compared to pre-pandemic times.
Death certificate data includes detailed information about individuals, including their occupation and industry that they held, which allowed the researchers to focus on essential workers, explains Alicia Riley, a sociologist and postdoctoral scholar at the University of California, San Francisco, who co-authored the study.
CNBC’s article continued:
Line cooks had a 60% increase in mortality associated with the pandemic.
The top five occupations that had higher than a 50% mortality rate increase during the pandemic include cooks, line workers in warehouses, agricultural workers, bakers and construction laborers.
A similar article was published by the San Francisco Chronicle on January 28 2021 with the headline, “Line cooks are at the highest risk of dying from COVID, says UCSF study”:
According to a new UCSF study, food and agricultural workers are at the highest risk of death from COVID-19 among working age Californians. The study, which analyzed deaths of essential workers between ages 18 to 65, found line cooks to be at the highest risk of all, more so than packaging machine operators, construction laborers and even nurses.
An embedded January 22 2021 tweet from a UCSF researcher included information from a pre-print:
Jobs associated w greatest risk of death during pandemic in CA?
Packaging machine operators
Sewing machine operators
Full list in new preprint @UCSF_Epibiostat https://t.co/FGtLWaHFHB pic.twitter.com/PSBwU99hxA
— Kirsten Bibbins-Domingo (@KBibbinsDomingo) January 22, 2021
CNBC linked to a pre-print of research [PDF] then pending peer-review in February 2021. The link in the embedded tweet directed to a version of the study, first published on June 4 2021 in the journal PLOS ONE.
That paper was titled “Excess mortality associated with the COVID-19 pandemic among Californians 18–65 years of age, by occupational sector and occupation: March through October 2020,” and its abstract read in part:
Background Though SARS-CoV-2 outbreaks have been documented in occupational settings and though there is speculation that essential workers face heightened risks for COVID-19, occupational differences in excess mortality have, to date, not been examined. Such information could point to opportunities for intervention, such as workplace modifications and prioritization of vaccine distribution.
Methods and findings Using death records from the California Department of Public Health, we estimated excess mortality among Californians 18–65 years of age by occupational sector and occupation, with additional stratification of the sector analysis by race/ethnicity. During the COVID-19 pandemic, working age adults experienced a 22% increase in mortality compared to historical periods. Relative excess mortality was highest in food/agriculture workers (39% increase), transportation/logistics workers (28% increase), facilities (27%) and manufacturing workers (23% increase). Latino Californians experienced a 36% increase in mortality, with a 59% increase among Latino food/agriculture workers. Black Californians experienced a 28% increase in mortality, with a 36% increase for Black retail workers. Asian Californians experienced an 18% increase, with a 40% increase among Asian healthcare workers. Excess mortality among White working-age Californians increased by 6%, with a 16% increase among White food/agriculture workers.
Conclusions Certain occupational sectors have been associated with high excess mortality during the pandemic, particularly among racial and ethnic groups also disproportionately affected by COVID-19. In-person essential work is a likely venue of transmission of coronavirus infection and must be addressed through strict enforcement of health orders in workplace settings and protection of in-person workers. Vaccine distribution prioritizing in-person essential workers will be important for reducing excess COVID mortality.
In the broader presentation of research, cooks were indeed listed among groups with the highest mortality per occupation:
Per-capita excess mortality was highest among transportation/logistics workers (91 per 100,000; 95% PI: 81–102), facilities workers (83; 95% PI: 67–98), food/agriculture workers (75; 95% PI: 66–85), and manufacturing workers (61; 95% PI: 57–64). Similarly, relative excess was highest among food/agriculture workers (39%; 95% PI: 32–45%) and transportation/logistics workers (31%; 95% PI: 26%–36%). Excess mortality among Californians in non-essential sectors was lower in both relative (12%; 95% PI 9–14) and per-capita measures (17 excess deaths per 100,000; 95% PI 14–20).
Among occupations with 20 or more recorded COVID-19 deaths (Table 4), relative excess mortality was highest among sewing machine operators (59%), cooks (57%), miscellaneous agricultural workers (54%), butchers and other meat workers (52%), and couriers and messengers (52%).
In the “Discussion” section, researchers explained that the risks of contracting the virus were not always entirely related to workplace, citing factors such as housing and access to healthcare — in other words, the problem was structural:
Our findings do not conclusively demonstrate that risks are entirely workplace related. Other factors may have led to excess mortality among certain occupational sectors, including crowded housing and access to healthcare. Disentanglement of such factors is outside the scope of the present study. However, we stress that whether transmission occurs at work is irrelevant to whether high-risk workers should be vaccinated: high-risk individuals will and should be protected by vaccination. Moreover, given the duration of time that individuals spend at work and documented weaknesses in workplace protection, workplace transmission seems likely. The public health response to the pandemic includes various policies and guidelines for minimizing transmission, including social-distance guidelines in public parks and financial support for infected individuals unable to safely quarantine; protections must absolutely exist at workplaces as well. In fact, non-workplace transmissions may in many cases be occupationally related; for example, the source for a household transmission may be a family member who became infected while on the job.
A subsequent passage explained that precision in calculating risk level by occupational classification was difficult, and further elaborated on why the research was conducted:
We recognize limitations to our findings, including misclassification of occupation in death certificates due to coarse categories or inaccurate reports. The decedent’s primary occupation is typically reported by the next of kin who may not be able to precisely describe the work. The primary occupation, which is reported on the death certificate, may not match the most recent occupation, which is more likely to drive occupational risk. These limitations would in general attenuate apparent differences across occupational sectors but are unlikely to account for our primary results. As with other studies using similar methods nationally, the number of excess deaths in our study exceed the number of COVID-confirmed death. While other causes of death might also have risen during the pandemic, the temporal pattern of excess mortality among other factors suggest that undiagnosed COVID-19 may be a key contributor. Regardless of the underlying cause, protecting working-age adults in occupations with higher deaths during the pandemic should be a focus of study and action.
In the section discussing “relative excess mortality,” cooks were a close second to “sewing machine operators,” at 57 percent to 59 percent. However, the tweet paired the study’s findings about a high rate of excess mortality for “cooks,” in the context of “no one wants to work anymore” signs at restaurants, specifically.
A viral tweet shared to Imgur expressed a wish that Anthony Bourdain were alive today “to articulate the insanity of living in a country where cooks were the largest occupational group to die in a pandemic and restaurant owners are pouting that nobody wants to work in restaurants anymore,” addressing both at-risk professions and discourse about the signs. Although the tweet did not mention the source of its assertion, UCSF researchers published a study on June 4 2021 indicating that cooks had the second-highest rate of occupational excess mortality. In a broader context of both issues — the “no one wants to work anymore” restaurant signs and then-newly published research, the claim was accurate.