A respiratory illness outbreak has killed two residents at a long-term care facility in Virginia and landed 18 others in the hospital after sickening a total of 54 over the last 11 days. The Fairfax County Health Department in Virginia said it is investigating the outbreak at Greenspring.

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The health department said in the news release that the individuals who died were hospitalized with pneumonia and had complex medical problems, but it “does not know the full medical history and the extent to which the pneumonia contributed to the deaths.”

Though a specific cause for the outbreak had not yet been found, health officials said care facilities are prone to respiratory outbreaks. However, they did note that while outbreaks typically occur in the winter months — this one was unusual as it has popped up in July. No new hospitalizations had been reported in recent days.

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A spokesperson for the facility told WTOP that staff remains “vigilant in our response” and will continue providing updates to residents and family members.

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“There has been excellent collaboration between Greenspring and the Health Department, and appropriate measures have been taken to reduce the risk of infection and keep residents safe, including close the facility to new admissions, canceling group activities, keeping ill residents in their rooms, and increasing cleaning,” the health department’s news release said.