Apr. 6, 2003 - First came 9/11, then an economic downturn, then war in Iraq. And now comes severe acute respiratory syndrome (SARS), the latest threat to an already ailing travel industry. 

The flulike virus has spread in a matter of weeks from Asia to at least 22 countries, infecting more than 2,200 people, killing upward of 80 and leading many travelers to question whether they should press on with their trips. 

Meanwhile, those returning from affected countries are getting conflicting advice from a medical community still sorting out virus-related protocol. 

Upping the confusion factor are three warnings urging travelers to postpone "nonessential" trips to Hong Kong and other affected regions. The language used in the advisories issued by the World Health Organization, the Centers for Disease Control and the U.S. State Department is strong, and so are the recommendations. 

But not so fast, counter some travel professionals. 

Jim Whillock, for one, stresses the need for perspective. 

"We're dealing with emotions here, with irrational fears," said Whillock, president of Patterson Travel in Sacramento. 

Whillock notes, for example, that the CDC travel warning includes all of mainland China, a nation with more than 1 billion inhabitants. "You've got to do the numbers," he said. "The biggest danger in going to China right now is getting run over by a truck." 

And besides, postponing a trip is easier said than done. 

Today, Whillock's agency is sending about 45 travelers to China on a 2 1/2 week tour scheduled to conclude in Hong Kong. 

"We're in kind of a bind," Whillock said earlier this week, acknowledging that several clients had called to express apprehension about going ahead with the trip. He had to tell them it was too late: Suppliers had been paid, the tour would go on (although the Hong Kong portion may be canceled). 

"If people decide not to go, they'll lose 99 percent of their money at this point," he said. "I feel sorry for people who feel afraid to go, but being afraid is not a reason to get their money back." 

It's easy for travelers reading health organization or State Department postings to become alarmed, and not just over SARS-related warnings, Whillock noted. 

"There's a CDC advisory on almost every place in the world. And if you spent very much time on the State Department Web site, you wouldn't ever leave home," he said. 

Such viewpoints are not meant to downplay the seriousness of SARS. Evidence has surfaced that the illness can be caught on airplanes, although the particulars of how it spreads are not clear. Last week, an American Airlines flight from Tokyo was detained on the runway in San Jose after several people aboard showed possible signs of the disease. It turned out to be a false alarm. 

While no one in the United States has died of SARS, the medical community is scrambling to develop a uniform policy toward travelers headed to affected countries or returning home from them. 

In an attempt to provide concrete information, the CDC last week launched a "travel alerting" program aimed at air, cruise and cargo ship passengers. 

"Right now, we are meeting both direct incoming flights from the affected areas as well as passengers who are arriving from different regions and have passed through those areas en route," CDC director Dr. Julie Gerdberding said in a media teleconference. 

Returning travelers at 23 U.S. ports of entry, including San Francisco, are being given a health-alert card advising them to watch for symptoms, she said. The agency plans to distribute about 25,000 of the notices daily until further notice. 

Meanwhile, the World Health Organization is urging officials in nations of SARS origin "to evaluate departing passengers for respiratory illnesses or other signs" that could be indicators of the disease, Dr. Gerdberding said. 

It has taken about a week for for the alerting program to get fully under way. 

Last week, about 80 people on a China tour with Travel Concepts International of Sacramento returned over a period of several days on China Air flights from Shanghai to San Francisco. Shanghai had not yet been added to the CDC list. 

"We were given nothing -- zip -- in the San Francisco airport," tour organizer Kathy Moroney said. "We'd been watching CNN (in China), picking up newspapers, the gossip was flying. People were scared they would be quarantined. But we got off the plane, went through immigration, went through customs and nobody asked us anything. So we thought the issue was being overblown." 

That was last Sunday. On Tuesday, Moroney's phone started ringing. People from her tour were calling their doctors, and the doctors' responses were all over the board. 

"We've gotten very mixed messages," she said. "Some were given chest X-rays, some were given antibiotics, some were told to wear face masks. One was told to quarantine herself. Others were told not to do anything unless they developed symptoms." 

The confusion and lack of uniform advice stem from the fact that SARS is an emerging disease, says Sacramento County Health Officer Dr. Glennah Trochet. 

"We're learning new things all the time," she said. "Things don't happen instantaneously. What we're saying to people who call us is to have their physician evaluate them and see if their symptoms fit the CDC case definition." 

Frequent hand-washing and avoidance of people showing possible SARS symptoms are recommended by the CDC as preventive measures. In Hong Kong, considered Ground Zero for the disease, a majority of people in the streets are wearing face masks. 

"You see that commonly in China," said Dr. Larry Stump, a Sacramento pediatrician who has traveled there several times over a period of 25 years. He recently returned from a two-week trip to Hong Kong and the mainland. 

"When I flew home on March 18, there was no particular advice to air travelers," he said. "But people are pretty concerned about it now." 

As for masks, Stump says that, "To my way of thinking, that's probably a pretty silly maneuver. If you put on a simple Chinese cotton mask, in about five minutes your own breath will have moisturized it, and any moisture outside will have worked its way right into your system." 

A good-quality surgical mask, on the other hand, can provide some protection, he said. "If I were forced to fly through Hong Kong today, I would probably take several good-quality surgical masks." 

Masks or no masks, officials in Hong Kong are scrambling to counter a sharp drop in business and leisure travel. 

"As can be expected, SARS has adversely impacted the tourism/travel industry," said Lily Shum, regional director in the Americas for the Hong Kong Tourism Board. Shum said advisory leaflets are being distributed to Hong Kong visitors and intense sanitation efforts are being implemented throughout the city of 6.8 million. 

The bottom line about travel is something every individual must decide. 

"We're providing our members with travel advisories and warnings so they can make their own informed decisions," said Jeff Hausman, Sacramento spokesman for the Kaiser Permanente health maintenance organization. 

Dr. Trochet with the county health department echoes that position. "There's no way we can make decisions for them," she said. "We can only give people as much information as we have, because this is an emerging disease." 

Coming at a time when public anxiety already is high, the SARS scare doesn't bode well for travelers or the businesses that serve them. But Patterson Travel's Whillock, like many who have nurtured their businesses through the ups and downs of economic boom, recession, terrorism and war, approaches this latest plague with a characteristic grain of salt. 

"I'm waiting for the locusts," he sighed. 

TRAVEL WISE: SARS CONTROL 

Following are links for information about SARS: 

-- Centers for Disease Control: www.cdc.gov/ 

-- U.S. State Department: http://travel.state.gov/ 

-- World Health Organization: www.who.int/en. 

-- County of Sacramento Department of Health and Human Services: (916) 875-5881 or sacdhhs.com/ article.asp?ContentID=957. 

When to be concerned: 

-- According to the Centers for Disease Control and Prevention, people who meet the following criteria should contact their doctor to be evaluated for SARS: 

-- A temperature of greater than 100.4 degrees Fahrenheit 

-- One or more clinical findings of respiratory illness, including cough, shortness of breath, difficulty in breathing, hypoxia and X-rays indicating the presence of pneumonia. 

-- History of travel to Hong Kong, mainland China, Vietnam, Singapore or Toronto within seven days of onset of symptoms. 

-- Close contact with persons with respiratory illness having the above history. 

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