Vermont is experiencing multiple coronavirus outbreaks that are growing and cases are turning up in more schools and child care programs, Health Commissioner Dr. Mark Levine said Friday, as the governor urged Vermonters to double down on efforts to contain the virus.

An outbreak stemming from an indoor ice rink in central Vermont has grown to nearly 90 coronavirus cases in 18 towns in four counties around the state, officials said.

“In Vermont, we’ve been proud of our work to keep COVID-19 from spreading for many months now. ... Our data showed that what we did worked even when other places struggled,” Levine said during the governor's twice-weekly virus briefing. “And while we should be proud we may have gotten a little too comfortable with our relative success thinking Vermont is different than other places.”

The outbreak associated with hockey and broomball leagues at the Central Vermont Memorial Civic Center in Montpelier led to four additional outbreaks, with the largest at St. Michael's College, which now has at least 41 cases, said Michael Pieciak, the commissioner of the Vermont Department of Financial Regulation. The three other subsequent outbreaks are at Union Elementary School in Montpelier and two businesses.

“Now we’re seeing what happens when we let our guard down, even just a little bit, here in Vermont,” Levine said.

Just one case can quickly spread to multiple communities, schools, worksites, colleges and other places, said state Epidemiologist Patsy Kelso.

“And the more cases we have, the more at risk we are for seeing hospitalizations, and perhaps deaths that result from those initial cases,” Kelso said.

The state reported 14 new cases of the coronavirus on Friday, with four people hospitalized and two in intensive care. The state's number of cases and test positivity rate is still among the lowest in the country, Republican Gov. Phil Scott said.

In the ice rink outbreak, investigations found that people were gathering indoors and outdoors in appropriate sizes, but at times they were not wearing masks, Kelso said.

“We've all been saying for months mask up, masks help prevent the spread, it's really, really important to do that,” Kelso saod. People also were not always following quarantines, whether they were identified as a close contact, had traveled, or had COVID-like symptoms.

“These things are what all of us need to do all the time to get a check on the spread of this virus,” she said. “All of the recommendations about wearing masks, and staying 6-feet apart, and not gathering unless you need to and being outdoors as much as possible, all those things are important because you can spread COVID-19 before you have any symptoms.”

Over the last several weeks, the Health Department has been following 11 situations in schools and three in child cares, many of which involve very small numbers, Levine said. While the state is doing very well considering the small number of schools and child cares affected, “any case represents a significant disruption,” he said.

He also warned that “the virus is making a dangerous comeback in many other parts of the country” with leaders in other states issuing dire warnings.

"The bottom line is this is the worst time to let COVID fatigue to set in,” Levine said.