A massive 69 car pileup in a Virginia interstate on Sunday led to 51 people being hospitalized, state authorities reported. The incident occurred on Interstate 64 in York County near Williamsburg.

Virginia State Police said ice and fog may have played a role in the chain-reaction crashes that began around 7:51 a.m. “Fog and ice were causative factors, but the cause of the actual accident, we do not know at this time,” said Virginia State Police spokeswoman Sgt. Michelle Anaya to NPR.

The police also reported that although the crash took place on the westbound lanes, drivers distracted by the crashes on the eastbound lanes also got into accidents. This resulted in a shut down of the westbound lane for 7 hours and the eastbound side for 3 hours.

Peter Glagola, spokesman for Riverside Regional Medical Center in Newport News, told USA today doctors there were treating 24 patients but that none had life-threatening injuries.

“One patient has serious injuries, five are being treated for moderate injuries, and 18 for minor injuries,” Glagola said. “More details to come.”

However, the Virginia Gazette reported that Steve Kopczyinski, the chief of York County Fire and Life Safety, said that out of 51 people taken to the hospital, seven injuries were considered serious and two were life-threatening.

Meanwhile, NPR reported that Shaun Stewart, the owner of the Williamsburg Flight Center, flew a plane over the wreckage Sunday morning and said he was shocked by what he saw.

“It was a bit shocking to see how they were all so tightly packed together,” Stewart said. “I have to imagine it was because of the heavy fog that was wafting all around this morning.”

Source: Major 69 Car Virginia Interstate Pileup Leads to More Than 50 Injuries