Some of the most horrific scenes early in the COVID-19 pandemic were in places like Italy and New York, where hospitals became overwhelmed with ailing and dying patients.The images were jarring, but those tragedies were taking place thousands of miles away in large cities.COVID-19 hit Iowa differently: After nearly a full year of the pandemic here — Monday marks the grim one-year anniversary -— data show the state’s rural areas, not its biggest cities, have been hit hardest by the virus.None of the 18 Iowa counties with the highest rates of COVID-19-related deaths per capita has a total population of more than 17,000 people, according to state public health data and U.S.