Early medical never accelerate timeline. Even in 2019 several files got delayed. Even medical is valid for 1 year till landing in canada. Hence its absolutely Wrong decision to go for upfront without AOR. Just wastage of money without any cause. Even now overall processing timeline for provincial nominee change to 22 months those who already applied (as per CIC website. Now if due to pandemic new strains populating and restrictions are strictly applied. All suffers. We never escape from present realistic situation.I think you should wait for AOR first