FYI, there are only 3 types of "status updates" for especially PNP applicants. They are:
- Application received
- Application in process
- Application approved/denied
So, e-CAS will not be updated for situations like: file transfer to local offices, medical received (unless they opened your file for processing) and so on. I want to point out one more thing here: your medical is sent to Ottawa first, it's reviewed there and then forwarded to Buffalo. It doesn't necessarily mean that they will open your file and start processing as soon as your medical reached Buffalo from Ottawa.
Besides, Buffalo will tell you
NOT to rely on e-CAS for all your update if you ever email them for any update information.