Humans express the alpha-2,3 sialic acid receptor on cells that line the surface of the eye (which explains why the dairy farm worker in Texas had severe conjunctivitis). The alpha-2,3 sialic acid receptor is also found on cells that line the lung. However, and most importantly, the alpha-2,3 sialic acid receptor is NOT found in cells that line the upper respiratory tract. This means that H5 viruses cannot reproduce themselves in the upper respiratory tract and thus be easily transmitted from one person to another. It also means that H5 viruses cannot amplify themselves in the upper respiratory tract, where hundreds of virus particles can become millions of virus particles.
https://pauloffit.substack.com/p/h5n1-influenza-virus-bird-f...