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BackgroundWestern Australia (WA) was in a unique position to experience coronavirus disease 2019 (COVID‐19) in a highly vaccinated and geographically isolated population.AimTo describe the COVID‐19 Omicron experience at the only quaternary hospital in WA following border opening from 3 March to 11 May 2022.ParticipantsA total of 158 adults with microbiologically confirmed COVID‐19 were admitted to the respiratory or intensive care unit (ICU).OutcomesAdmission numbers, disease severity, prevalence of COVID‐19 deterioration risk factors, immunisation status, severity of infection, immunosuppression and treatment regimen.ResultsOne hundred fifty‐eight COVID‐19–positive patients were admitted to the respiratory ward (n = 123) and the ICU (n = 35) during the study period. COVID‐19 infection was the primary admission reason in 32.9% of patients, 51.3% were male and the median age was 62 years. Aboriginal or Torres Strait Islanders (ATSI) were overrepresented (13.3%).Care was predominantly ward based (77.2%). Nearly half of the patients had mild COVID‐19 (49.4%). Dexamethasone was the most common treatment provided to patients (58.2%). The median length of stay was 5.8 days (interquartile range, 5–15). Eight patients died during the study period (5.1%), with three of those deaths attributable to COVID‐19.ConclusionsCOVID‐19 case numbers following WA state border opening were of lower care acuity and disease severity than predicted. Two‐thirds of admissions were for other primary diagnoses, with incidental COVID detection. Hospital admissions were overrepresented by partially or unvaccinated patients and by ATSI Australians. An increase in social support along with general and geriatric medicine speciality input were required to treat hospitalised COVID‐19 cases in the WA Omicron wave.